摘要目的 探讨运用骨水泥强化椎弓根螺钉内固定治疗老年骨质疏松性胸腰椎压缩骨折经皮椎体后凸成形术(PKP)后手术椎体再骨折并发下肢神经症状的临床疗效. 方法 采用回顾性病例系列研究分析2013年12月-2016年12月收治的123例骨质疏松性胸腰椎压缩骨折行PKP治疗患者临床资料,共12例术后发生手术椎体再次骨折并压迫脊髓或马尾神经,其中男5例,女7例;年龄(69.2±7.1)岁.伤椎分布:T125例,L15例,L2 2例,均采用脊柱后路椎管减压、骨水泥强化椎弓根螺钉内固定术手术.比较术前、术后1周及末次随访时视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、椎体前缘压缩率、椎体后凸Cobb角、术中和术后并发症. 结果 12例患者获随访12 ～ 36个月,平均26.7个月.术中无神经损伤或硬膜撕裂,无明显骨水泥渗漏、骨水泥毒性反应或肺栓塞,术后X线片示骨水泥分布于钉道及周围松质骨中,无椎体外渗漏.术后1周腰痛VAS、下肢痛VAS及ODI分别为(2.2±0.7)分、(2.2±0.4)分和(33.3±8.9)分,与术前比较,差异有统计学意义(P均＜0.01).椎体前缘压缩率由术前(71.5±11.7)％下降到术后1周的(18.7±10.3)％(P＜0.01).后凸Cobb角从术前(28.3±7.6)°纠正至术后1周的(7.1±2.3)°(P＜0.01).患者腰痛、双下肢麻木及无力症状明显缓解.末次随访时各评价指标与术后1周比较差异均无统计学意义(P＞0.05). 结论 对于胸腰椎压缩性骨折、PKP术后手术椎体再次骨折并引起脊髓或马尾神经压迫症状的老年骨质疏松患者,采用后路骨水泥强化椎弓根螺钉内固定可有效矫正后凸畸形,缓解神经症状及恢复脊柱稳定性.

abstractsObjective To investigate the clinical therapeutic effects of bone cement-augmented pedicle screw fixation for cement vertebrae refractures with lower limb neurological symptoms after percutaneous kyphoplasty (PKP) in elderly patients with osteoporotic thoracolumbar compression fractures.Methods A total of 123 elderly patients with osteoporotic thoracolumbar compression fractures underwent PKP from December 2013 to December 2016 were retrospectively analyzed by case series study.Twelve patients had vertebral refracture with compression of the spinal cord or cauda equina which resulted in lumbosacral and leg pain,numbness and disability of ambulation and there were five males and seven females,with age of (69.2 ± 7.1) years.Injured vertebrae was located at T12 in five cases,at L1 in five and at L2 in two.Bone cement-augmented pedicle screw fixation through a standard posterior approach was utilized to treat all the 12 patients.Visual analogue scale (VAS),Oswestry disability index (ODI),anterior vertebral height compression ratio,and kyphotic angle at the preoperative time,one week postoperatively and last follow-up were recorded and compared.Intraoperative and postoperative complications were also recorded.Results The mean duration of follow-up in all the patients was 26.7 months (range,12-36 months).Intraoperative nerve injury,dural tear,leakage of bone cement,bone cement toxicity reaction,and pulmonary embolism were not observed during the surgery.The postoperative radiographs for all the 12 patients showed that the bone cement was distributed in cancellous bone and around the screw appropriately where there was no cement leakage out of the vertebral body or pedicle.Compared with preoperative scores,the average low back pain VAS,leg pain VAS and ODI at postoperative one week were improved by (2.2 ± 0.7) points,(2.2 ± 0.4) points and (33.2 ± 8.9) points,respectively (P ＜ 0.01).Anterior vertebral height compression ratio was decreased from preoperative (71.5 ± 11.7) ％ to (18.7 ± 10.3) ％ at postoperative one week (P ＜ 0.01).The mean kyphotic angle was corrected from preoperative (28.3 ± 7.6) ° to (7.1 ± 2.3) ° at postoperative one week (P ＜ 0.01).The symptoms of lumbar pain,and numbness and weakness of lower limbs were improved significantly.There was no statistically significant difference of all the parameters between the last follow-up evaluation and one week post-operatively (P ＞ 0.05).Conclusion For elderly patients with spinal cord or cauda equina nerve compression symptoms after PKP for osteoporotic thoracolumbar compression fractures,the usage of posterior approach bone cement-augmented pedicle screw fixation can effectively correct kyphosis,relieve neurological symptoms and restore spinal stability.