后路長節段固定聯合椎體成形術治療重度骨質疏松胸腰椎壓縮骨折療效觀察_《中國修復重建外科雜志》

作者：

許子星 , 許衛紅 , 王長昇 , 羅鴻斌 , 李貴雙 , 陳榮生

福建醫科大學附屬第一醫院脊柱外科（福州，350005）;

關鍵詞：

長節段固定聯合椎體成形術骨質疏松胸腰椎壓縮骨折后凸畸形

DOI：

10.7507/1002-1892.20130290

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目的觀察經后路長節段固定聯合椎體成形術（long segment fixation combined with vertebroplasty，LSF-VP）治療重度骨質疏松胸腰椎壓縮骨折合并后凸畸形的臨床療效。方法回顧性分析2006年3月－2012年5 月，分別采用LSF-VP 和經皮椎體后凸成形術（percutaneous kyphoplasty，PKP）治療椎體前緣壓縮超過50%或后凸畸形Cobb角 gt; 40°的重度骨質疏松胸腰椎壓縮骨折患者48例（LSF-VP組27例，PKP組21例）。均為T11～L2單椎體壓縮骨折，兩組患者性別、年齡、受累節段、骨密度T值等一般資料比較，差異均無統計學意義（P gt; 0.05），具有可比性。比較兩組手術前、后疼痛視覺模擬評分（VAS）、胸腰椎后凸Cobb角、椎體前緣高度、椎體后緣高度和椎體壓縮比等指標，對療效進行評估。結果LSF-VP組手術時間、住院時間及骨水泥注射量均高于PKP組（P lt; 0.05）。LSF-VP組術中出血量為220～1 050 mL，平均517 mL。兩組均無肺、腦栓塞、腦脊液漏等并發癥發生。LSF-VP組和PKP組分別有3例和2例發生無癥狀性骨水泥滲漏。兩組患者均獲隨訪，LSF-VP組隨訪時間16～78個月，平均41.1個月；PKP組隨訪時間12～71個月，平均42.1個月。LSF-VP組隨訪期間未見螺釘松動、斷裂等內固定失敗發生；無再骨折及鄰近椎體骨折發生。PKP組2例分別在術后39、56個月胸腰痛復發、椎體高度維持欠佳且矯正角度丟失（Cobb角 gt; 40°），另1例于術后16個月出現病椎前緣高度下降、鄰近節段重度壓縮骨折合并后凸畸形，3例患者二次手術均給予LSF-VP治療。LSF-VP組除胸腰段后凸Cobb角、椎體后緣高度在出院當天和末次隨訪時比較差異無統計學意義（P gt; 0.05）外，其余各指標各時間點間比較差異均有統計學意義（P lt; 0.05）；PKP組除胸腰段后凸Cobb角、椎體壓縮比在出院當天和末次隨訪時比較差異無統計學意義（P gt; 0.05）外，其余各指標各時間點間比較差異均有統計學意義（P lt; 0.05）。術后兩組間除出院當天VAS評分和椎體后緣高度比較差異無統計學意義（P gt; 0.05）外，其余各指標各時間點LSF-VP組均顯著優于PKP組，差異有統計學意義（P lt; 0.05）。結論與PKP相比，LSF-VP術治療重度骨質疏松性胸腰椎壓縮骨折合并后凸畸形，能夠獲得更好的畸形矯正和椎體高度維持，療效更滿意。

引用本文： 許子星,許衛紅,王長昇,羅鴻斌,李貴雙,陳榮生. 后路長節段固定聯合椎體成形術治療重度骨質疏松胸腰椎壓縮骨折療效觀察. 中國修復重建外科雜志, 2013, 27(11): 1331-1337. doi: 10.7507/1002-1892.20130290 復制

1.	Vougioukas V, Hubbe U, Kogias E, et al. Vertebroplasty combined with image-guided percutaneous cement augmented transpedicular fixation for the treatment of complex vertebral fractures in osteoporotic patients. J Neurosurg Sci, 2010, 54(4): 135-141.
2.	Mclain RF. The biomechanics of long versus short fixation for thoracolumbar spine fractures. Spine (Phila Pa 1976), 2006, 31(11 Suppl): S70-79, S104.
3.	Heini PF. Comment on “Transpedicle body augmenter in painful osteoporotic compression fractures”. Eur Spine J, 2007, 16(5): 599-600.
4.	Blondel B, Fuentes S, Metellus P, et al. Severe thoracolumbar osteoporotic burst fractures: treatment combining open kyphoplasty and short-segment fixation. Orthop Traumatol Surg Res, 2009, 95(5): 359-364.
5.	Gan M, Yang H, Zhou F, et al. Kyphoplasty for the treatment of painful osteoporotic thoracolumbar burst fractures. Orthopedics, 2010, 33(2): 88-92.
6.	Yan D, Duan L, Li J, et al. Comparative study of percutaneous vertebroplasty and kyphoplasty in the treatment of osteoporotic vertebral compression fractures. Arch Orthop Trauma Surg, 2011, 131(5): 645-650.
7.	Burval DJ, Mclain RF, Milks R, et al. Primary pedicle screw augmentation in osteoporotic lumbar vertebrae: biomechanical analysis of pedicle fixation strength. Spine (Phila Pa 1976), 2007, 32(10): 1077-1083.
8.	Kim KH, Kuh SU, Chin DK, et al. Kyphoplasty versus vertebroplasty: restoration of vertebral body height and correction of kyphotic deformity with special attention to the shape of the fractured vertebrae. J Spinal Disord Tech, 2012, 25(6): 338-344.
9.	Okuyama K, Abe E, Suzuki T, et al. Influence of bone mineral density on pedicle screw fixation: a study of pedicle screw fixation augmenting posterior lumbar interbody fusion in elderly patients. Spine J, 2001, 1(6): 402-407.
10.	Cho DY, Lee WY, Sheu PC. Treatment of thoracolumbar burst fractures with polymethyl methacrylate vertebroplasty and short-segment pedicle screw fixation. Neurosurgery, 2003, 53(6): 1354-1361.
11.	Afzal S, Akbar S, Dhar SA. Short segment pedicle screw instrumentation and augmentation vertebroplasty in lumbar burst fractures: an experience. Eur Spine J, 2008, 17(3): 336-341.
12.	Pflugmacher R, Agarwal A, Kandziora F, et al. Balloon kyphoplasty combined with posterior instrumentation for the treatment of burst fractures of the spine—1-year results. J Orthop Trauma, 2009, 23(2): 126-131.
13.	Marco RA, Meyer BC, Kushwaha VP. Thoracolumbar burst fractures treated with posterior decompression and pedicle screw instrumentation supplemented with balloon-assisted vertebroplasty and calcium phosphate reconstruction. Surgical technique. J Bone Joint Surg (Am), 2010, 92 Suppl 1 Pt 1: 67-76.
14.	Wu ZX, Gao MX, Sang HX, et al. Surgical treatment of osteoporotic thoracolumbar compressive fractures with open vertebral cement augmentation of expandable pedicle screw fixation: a biomechanical study and a 2-year follow-up of 20 patients. J Surg Res, 2012, 173(1): 91-98.
15.	Knop C, Bastian L, Lange U, et al. Complications in surgical treatment of thoracolumbar injuries. Eur Spine J, 2002, 11(3): 214-226.
16.	Li KC, Hsieh CH, Lee CY, et al. Transpedicle body augmenter: a further step in treating burst fractures. Clin Orthop Relat Res, 2005, (436): 119-125.
17.	Alanay A, Acaroglu E, Yazici M, et al. Short-segment pedicle instrumentation of thoracolumbar burst fractures: does transpedicular intracorporeal grafting prevent early failure? Spine (Phila Pa 1976), 2001, 26(2): 213-217.
18.	Wong CC, McGirt MJ. Vertebral compression fractures: a review of current management and multimodal therapy. J Multidiscip Healthc, 2013, 17(6): 205-214.
19.	Modi HN, Chung KJ, Seo IW, et al. Two levels above and one level below pedicle screw fixation for the treatment of unstable thoracolumbar fracture with partial or intact neurology. J Orthop Surg Res, 2009, 4: 28.
20.	Kim HS, Lee SY, Nanda A, et al. Comparison of surgical outcomes in thoracolumbar fractures operated with posterior constructs having varying fixation length with selective anterior fusion. Yonsei Med J, 2009, 50(4): 546-554.
21.	Tezeren G, Kuru I. Posterior fixation of thoracolumbar burst fracture: short-segment pedicle fixation versus long-segment instrumentation. J Spinal Disord Tech, 2005, 18(6): 485-488.
22.	Oken F, Yildirim O, Oken O, et al. Short or long fusion after thoracolumbar burst fractures does not alter selected gait parameters: a preliminary study. J Orthop Res, 2011, 29(6): 915-918.
23.	Gao M, Lei W, Wu Z, et al. Biomechanical evaluation of fixation strength of conventional and expansive pedicle screws with or without calcium based cement augmentation. Clin Biomech (Bristol, Avon), 2011, 26(3): 238-244.
24.	Heini PF. The current treatment—a survey of osteoporotic fracture treatment. Osteoporotic spine fractures: the spine surgeon’s perspective. Osteoporos Int, 2005, 16 Suppl 2: S85-92.
25.	Frankel BM, D’Agostino S, Wang C. A biomechanical cadaveric analysis of polymethylmethacrylate-augmented pedicle screw fixation. J Neurosurg Spine, 2007, 7(1): 47-53.

1. Vougioukas V, Hubbe U, Kogias E, et al. Vertebroplasty combined with image-guided percutaneous cement augmented transpedicular fixation for the treatment of complex vertebral fractures in osteoporotic patients. J Neurosurg Sci, 2010, 54(4): 135-141.
2. Mclain RF. The biomechanics of long versus short fixation for thoracolumbar spine fractures. Spine (Phila Pa 1976), 2006, 31(11 Suppl): S70-79, S104.
3. Heini PF. Comment on “Transpedicle body augmenter in painful osteoporotic compression fractures”. Eur Spine J, 2007, 16(5): 599-600.
4. Blondel B, Fuentes S, Metellus P, et al. Severe thoracolumbar osteoporotic burst fractures: treatment combining open kyphoplasty and short-segment fixation. Orthop Traumatol Surg Res, 2009, 95(5): 359-364.
5. Gan M, Yang H, Zhou F, et al. Kyphoplasty for the treatment of painful osteoporotic thoracolumbar burst fractures. Orthopedics, 2010, 33(2): 88-92.
6. Yan D, Duan L, Li J, et al. Comparative study of percutaneous vertebroplasty and kyphoplasty in the treatment of osteoporotic vertebral compression fractures. Arch Orthop Trauma Surg, 2011, 131(5): 645-650.
7. Burval DJ, Mclain RF, Milks R, et al. Primary pedicle screw augmentation in osteoporotic lumbar vertebrae: biomechanical analysis of pedicle fixation strength. Spine (Phila Pa 1976), 2007, 32(10): 1077-1083.
8. Kim KH, Kuh SU, Chin DK, et al. Kyphoplasty versus vertebroplasty: restoration of vertebral body height and correction of kyphotic deformity with special attention to the shape of the fractured vertebrae. J Spinal Disord Tech, 2012, 25(6): 338-344.
9. Okuyama K, Abe E, Suzuki T, et al. Influence of bone mineral density on pedicle screw fixation: a study of pedicle screw fixation augmenting posterior lumbar interbody fusion in elderly patients. Spine J, 2001, 1(6): 402-407.
10. Cho DY, Lee WY, Sheu PC. Treatment of thoracolumbar burst fractures with polymethyl methacrylate vertebroplasty and short-segment pedicle screw fixation. Neurosurgery, 2003, 53(6): 1354-1361.
11. Afzal S, Akbar S, Dhar SA. Short segment pedicle screw instrumentation and augmentation vertebroplasty in lumbar burst fractures: an experience. Eur Spine J, 2008, 17(3): 336-341.
12. Pflugmacher R, Agarwal A, Kandziora F, et al. Balloon kyphoplasty combined with posterior instrumentation for the treatment of burst fractures of the spine—1-year results. J Orthop Trauma, 2009, 23(2): 126-131.
13. Marco RA, Meyer BC, Kushwaha VP. Thoracolumbar burst fractures treated with posterior decompression and pedicle screw instrumentation supplemented with balloon-assisted vertebroplasty and calcium phosphate reconstruction. Surgical technique. J Bone Joint Surg (Am), 2010, 92 Suppl 1 Pt 1: 67-76.
14. Wu ZX, Gao MX, Sang HX, et al. Surgical treatment of osteoporotic thoracolumbar compressive fractures with open vertebral cement augmentation of expandable pedicle screw fixation: a biomechanical study and a 2-year follow-up of 20 patients. J Surg Res, 2012, 173(1): 91-98.
15. Knop C, Bastian L, Lange U, et al. Complications in surgical treatment of thoracolumbar injuries. Eur Spine J, 2002, 11(3): 214-226.
16. Li KC, Hsieh CH, Lee CY, et al. Transpedicle body augmenter: a further step in treating burst fractures. Clin Orthop Relat Res, 2005, (436): 119-125.
17. Alanay A, Acaroglu E, Yazici M, et al. Short-segment pedicle instrumentation of thoracolumbar burst fractures: does transpedicular intracorporeal grafting prevent early failure? Spine (Phila Pa 1976), 2001, 26(2): 213-217.
18. Wong CC, McGirt MJ. Vertebral compression fractures: a review of current management and multimodal therapy. J Multidiscip Healthc, 2013, 17(6): 205-214.
19. Modi HN, Chung KJ, Seo IW, et al. Two levels above and one level below pedicle screw fixation for the treatment of unstable thoracolumbar fracture with partial or intact neurology. J Orthop Surg Res, 2009, 4: 28.
20. Kim HS, Lee SY, Nanda A, et al. Comparison of surgical outcomes in thoracolumbar fractures operated with posterior constructs having varying fixation length with selective anterior fusion. Yonsei Med J, 2009, 50(4): 546-554.
21. Tezeren G, Kuru I. Posterior fixation of thoracolumbar burst fracture: short-segment pedicle fixation versus long-segment instrumentation. J Spinal Disord Tech, 2005, 18(6): 485-488.
22. Oken F, Yildirim O, Oken O, et al. Short or long fusion after thoracolumbar burst fractures does not alter selected gait parameters: a preliminary study. J Orthop Res, 2011, 29(6): 915-918.
23. Gao M, Lei W, Wu Z, et al. Biomechanical evaluation of fixation strength of conventional and expansive pedicle screws with or without calcium based cement augmentation. Clin Biomech (Bristol, Avon), 2011, 26(3): 238-244.
24. Heini PF. The current treatment—a survey of osteoporotic fracture treatment. Osteoporotic spine fractures: the spine surgeon’s perspective. Osteoporos Int, 2005, 16 Suppl 2: S85-92.
25. Frankel BM, D’Agostino S, Wang C. A biomechanical cadaveric analysis of polymethylmethacrylate-augmented pedicle screw fixation. J Neurosurg Spine, 2007, 7(1): 47-53.

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后路長節段固定聯合椎體成形術治療重度骨質疏松胸腰椎壓縮骨折療效觀察

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《中國修復重建外科雜志》

后路長節段固定聯合椎體成形術治療重度骨質疏松胸腰椎壓縮骨折療效觀察

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