胸腰重度骨质疏松性骨折短节段固定椎体成形

Short-segment pedicle screw fixation combined with vertebroplasty for severe thoracolumbar osteoporotic fractures

摘要:

[目的] 评价经 Wiltse 入路行短节段椎弓根螺钉内固定 （short-segment pedicle screw fixation, SPSF） 联合椎体成形术 （vertebroplasty, VP） 治疗 Genant III 度的骨质疏松性椎体骨折 （Genant grade III osteoporotic vertebral compression fractures, Genant III OVCFs） 的临床效果。[方法] 回顾性分析 2019 年 4 月—2020 年 6 月采用上述方法治疗 Genant III OVCFs 的 48 例患者的临床资料，评价临床和影像学指标。[结果] 48 例患者均顺利手术，手术时间平均 （72.9±8.1） min，术中出血量平均 （52.7± 9.5）ml，骨水泥注入量平均 （6.1±0.4）ml。48 例患者随访时间 12~24 个月，平均（17.4±4.4）个月。与术前相比，术后 7 d 和末次随访时 VAS 评分 [(7.5±0.7), (2.2±0.5), (2.1±0.6), P＜0.05] 及 ODI 评分 [(82.4±3.1), (28.3±3.0), (26.9±3.3), P＜0.05] 均显著减少。 影像方面，与术前相比，术后 7 d 及末次随访时局部后凸 Cobb 角和椎体相对高度均显著改善（P＜0.05）。[结论]Wiltse 入路行 SPSF 联合 VP 治疗 Genant III-OVCFs 安全有效，恢复椎体高度、矫正后凸畸形、强化椎体并重建生物力学稳定。

Abstract:

[Objective] To evaluate the clinical outcomes of short-segment pedicle screw fixation (SPSF) combined with vertebroplasty (VP) through Wiltse approach for Genant grade III osteoporotic vertebral compression fractures (Genant III OVCFs). [Methods] A retrospec- tive study was performed on 48 patients who received abovementioned procedures for Genant III OVCFs from April 2019 to June 2020. The clinical and imaging consequences were evaluated. [Results] All the 48 patients were successfully operated on with the average operation time of (72.9±8.1) min, intraoperative blood loss of (52.7±9.5) ml, and the volume of bone cement injected of (6.1±0.4) ml. All the 48 pa- tients were followed up for 12~24 months, with an average of (17.4±4.4) months. Compared with those preoperatively, 7 days postoperative- ly and the latest follow-up the VAS scores [(7.5±0.7), (2.2±0.5), (2.1±0.6), P＜0.05] and ODI score [(82.4±3.1), (28.3±3.0), (26.9±3.3), P＜ 0.05] significantly reduced. Radiographically, the local kyphotic Cobb angle and relative vertebral body height significantly improved 7 days after surgery and at the last follow- up compared with those preoperatively (P＜0.05). [Conclusion] The SPSF combined with VP through Wiltse approach is safe and effective to restore vertebral height, correct kyphotic deformity, strengthen vertebral body, and reestab- lish biomechanical stability for the Genant III OVCFs