CAJ | 학술논문

背景：经皮椎体成形治疗是针对骨质疏松性椎体压缩骨折一种有效的微创疗法，但在临床应用过程也存在一定的不足，如不能恢复椎体高度及矫正局部后凸畸形，同时骨水泥渗漏发生率较高。 　　目的：评价脊柱外固定器撑开复位结合椎体成形治疗骨质疏松性椎体骨折的近期临床疗效。 　　方法：2012年1月至2013年6月采用脊柱外固定器撑开复位结合椎体成形治疗骨质疏松性严重椎体骨折患者55例。术中先采用经皮椎弓根钉脊柱外固定器撑开闭合复位矫正脊柱后凸畸形，然后再经皮穿刺行伤椎椎体成形治疗。测量治疗前后压缩骨折椎体高度压缩率、后凸畸形角度及椎管内狭窄占位率。同时采用目测类比评分法和Oswestry功能障碍指数评估临床疗效。 　　结果与结论：患者治疗后和末次随访时的目测类比评分和 Oswestry 功能障碍指数与治疗前比较均明显改善(P<0.05)，患者腰背痛基本缓解，治疗后1-3 d可下床活动。55例共57个椎体出现骨水泥渗漏4例，但无明显临床症状。经脊柱外固定器整复结合椎体成形治疗后和末次随访时的压缩骨折椎体高度、后凸畸形角度及椎管内狭窄占位率均较治疗前显著改善(P<0.05)，治疗后与末次随访相比差异无显著性意义。提示脊柱外固定器撑开复位结合经皮椎体成形治疗骨质疏松性严重椎体骨折是一种安全有效且疗效稳定的微创修复方法，骨水泥渗漏率低，可获得满意的脊柱稳定性。
배경：경피추체성형치료시침대골질소송성추체압축골절일충유효적미창요법，단재림상응용과정야존재일정적불족，여불능회복추체고도급교정국부후철기형，동시골수니삼루발생솔교고。 　　목적：평개척주외고정기탱개복위결합추체성형치료골질소송성추체골절적근기림상료효。 　　방법：2012년1월지2013년6월채용척주외고정기탱개복위결합추체성형치료골질소송성엄중추체골절환자55례。술중선채용경피추궁근정척주외고정기탱개폐합복위교정척주후철기형，연후재경피천자행상추추체성형치료。측량치료전후압축골절추체고도압축솔、후철기형각도급추관내협착점위솔。동시채용목측류비평분법화Oswestry공능장애지수평고림상료효。 　　결과여결론：환자치료후화말차수방시적목측류비평분화 Oswestry 공능장애지수여치료전비교균명현개선(P<0.05)，환자요배통기본완해，치료후1-3 d가하상활동。55례공57개추체출현골수니삼루4례，단무명현림상증상。경척주외고정기정복결합추체성형치료후화말차수방시적압축골절추체고도、후철기형각도급추관내협착점위솔균교치료전현저개선(P<0.05)，치료후여말차수방상비차이무현저성의의。제시척주외고정기탱개복위결합경피추체성형치료골질소송성엄중추체골절시일충안전유효차료효은정적미창수복방법，골수니삼루솔저，가획득만의적척주은정성。
BACKGROUND:Percutaneous vertebroplasty is an effective minimal y invasive method in the treatment of osteoporotic vertebral compression fractures. However, there are some shortcomings during clinical application, such as cannot recover vertebral height or correct local kyphosis, as wel as the incidence of cement leakage is very high. OBJECTIVE:To evaluate the latest clinical effect of spinal external fixator distraction reduction combined with vertebroplasty for osteoporotic vertebral fractures. METHODS:From January 2012 to June 2013, 55 sever osteoporotic fracture patients accepted the treatment of spinal external fixator distraction reduction combined with vertebroplasty. During the operation, we firstly used percutaneous pedicle screw fixator to open the closed reduction and to correct the kyphosis, fol owed by vertebroplasty via percutaneous puncture. Then we measured the compression rate of vertebral body of compression fracture, the kyphosis angle and the rate of intraspinal occupancy before and after operation. Meanwhile, we evaluated the clinical effect with Visual Analogue Scale and Oswestry disability index. RESULTS AND CONCLUSION:Visual Analogue Scale scores and Oswestry disability index were significantly improved after treatment and during final fol ow-up (P<0.05). Low back pain was basical y relieved. The patients could do out-of-bed activity at 1-3 days after treatment. Among the 57 vertebral bodies of 55 cases, 4 suffered from the cement leakage without obvious clinical symptoms. The height of vertebral compression fracture, the kyphosis angle, and the rate of intraspinal occupancy were significantly improved after the spinal external fixator combined with vertebroplasty and during the last fol ow-up (P<0.05), and no significant difference was detected between postoperation and final fol ow-up. These data indicated that spinal external fixator distraction reduction combined with percutaneous vertebroplasty for severe osteoporotic vertebral compression fractures is a safe effective minimal y invasive method with stable therapeutic effects. Cement leakage rate was low, and spinal stability was satisfactory.