Objective: To evaluate the effectiveness of cement-injectable cannulated pedicle screw combined with multiple level Schwab grade Ⅰ osteotomy for chronic thoracolumbar osteoporotic fractures with kyphosis.
Methods: The clinical data of 27 patients with symptomatic chronic thoracolumbar osteoporotic fractures combined with kyphosis treated between June 2015 and June 2017 were retrospectively analysed. Among them, there were 8 males and 19 females, with an average age of 69.5 years (range, 56-81 years). The damage segment (kyphosis vertex) included T 11 in 4 cases, T 12 in 12 cases, L 1 in 10 cases, and L 2 in 1 case. The disease duration ranged from 3 to 21 months, with an average of 12.5 months. The T value of lumbar vertebral bone mineral density ranged from -4.9 to -2.5, with an average value of -3.61. The American Spinal Injury Association (ASIA) classification was used to evaluate spinal cord injury, there were 1 case of grade D and 26 cases of grade E. The visual analogue scale (VAS) score, Oswestry disability index (ODI), kyphosis Cobb angle of fracture site, and sagittal vertical axis (SVA) data were obtained before operation, at 2 weeks after operation, 3 months after operation, and last follow-up, to evaluate the quality of life and improvement of sagittal spine parameters.
Results: No complications related to pedicle screw and bone cement occurred. The incisions healed by first intention in 26 cases, and 1 incision healed after dressing change due to poor blood glucose control. There were no complications such as bedsore, hypostatic pneumonia, or deep venous thrombosis. All patients were followed up 8-24 months, with an average of 16.6 months. The VAS score, ODI score, Cobb angle, and SVA were significantly improved when compared with those before operation ( P<0.05). There was no significant difference in Cobb angle between each time point after operation ( P>0.05); the VAS score and ODI score at 3 months after operation and last follow-up were significantly better than those at 2 weeks after operation ( P<0.05), and the ODI score at last follow-up was further improved when compared with the score at 3 months ( P<0.05), but there was no significant difference in VAS score ( P>0.05); SVA at last follow-up was significantly worse than that at 2 weeks and 3 months after operation ( P<0.05), but there was no significant difference between at 2 weeks and 3 months after operation ( P>0.05). During the follow-up period, there was no complication such as pedicle screw loosening, breakage or cutting, adjacent vertebral fracture, proximal junctional kyphosis, and so on.
Conclusion: For the chronic thoracolumbar osteoporotic fractures combined with kyphosis, the cement-injectable cannulated pedicle screw and multiple level Schwab grade Ⅰ osteotomy has the advantages of less operation trauma, quick recovery, and remarkable effectiveness.
目的: 探讨骨水泥螺钉联合多节段 SchwabⅠ级截骨治疗陈旧性胸腰椎骨质疏松性骨折伴后凸畸形的临床疗效。.
方法: 回顾分析 2015 年 6 月—2017 年 6 月收治且符合选择标准的 27 例陈旧性胸腰椎骨质疏松性骨折伴后凸畸形患者。男 8 例，女 19 例；年龄 56～81 岁，平均 69.5 岁。损伤节段（后凸顶点）：T 11 4 例、T 12 12 例、L 1 10 例、L 2 1 例。病程 3～21 个月，平均 12.5 个月。腰椎骨密度 T 值 −4.9～−2.5，平均 −3.61。采用美国脊髓损伤协会（ASIA）分级评价脊髓损伤情况，D 级 1 例，E 级 26 例。分别于术前、术后 2 周、术后 3 个月及末次随访时获得患者胸腰部疼痛视觉模拟评分（VAS）、Oswestry 功能障碍指数（ODI）、骨折部位后凸 Cobb 角及脊柱矢状面轴向距离（sagittal vertical axis，SVA）数据，评估患者生活质量和脊柱矢状面参数改善情况。.
结果: 患者术中未出现椎弓根螺钉植钉和骨水泥相关并发症。术后 26 例切口Ⅰ期愈合；1 例因血糖控制不佳切口愈合不良，经换药后愈合。术后未出现褥疮、坠积性肺炎及下肢深静脉血栓形成等并发症。27 例患者均获随访，随访时间 8～24 个月，平均 16.6 个月。术后各时间点 VAS 评分、ODI 评分、Cobb 角及 SVA 均较术前显著改善（ P<0.05）。术后各时间点间 Cobb 角比较差异均无统计学意义（ P>0.05）；术后 3 个月及末次随访时 VAS 评分和 ODI 评分显著优于术后 2 周（ P<0.05），与术后 3 个月时比较，末次随访时 ODI 评分进一步改善（ P<0.05），而 VAS 评分差异无统计学意义（ P>0.05）；末次随访时 SVA 与术后 2 周及 3 个月比较差异有统计学意义（ P<0.05），术后 2 周及 3 个月间差异无统计学意义（ P>0.05）。随访期间均未发现椎弓根螺钉松动、断裂或切割，邻近节段椎体骨折，近端交界性后凸畸形等并发症。.
结论: 采用骨水泥螺钉联合多节段 SchwabⅠ级截骨治疗陈旧性胸腰椎骨质疏松性骨折伴后凸畸形手术创伤小、术后恢复快，临床疗效显著。.
Keywords: Cement-injectable cannulated pedical screw; Schwab gradeⅠosteotomy; kyphosis; osteoporosis; thoracolumbar fracture.