摘要
目的探讨后路翻修术治疗胸腰椎骨质疏松性压缩骨折经皮椎体成形术(PVP)或经皮椎体后凸成形术(PKP)术后骨水泥椎管内渗漏致脊髓损伤的临床疗效。方法采用后路翻修术治疗8例胸腰椎骨质疏松性压缩骨折PVP或PKP术后骨水泥椎管内渗漏导致的脊髓损伤患者,5例行后路长节段椎弓根钉棒内固定,3例行单纯后路次全椎板切开减压。观察临床症状缓解情况、双下肢肌力和神经功能恢复情况。结果患者均获得随访,时间7~26个月。末次随访时,5例临床症状缓解,双下肢肌力已恢复至Ⅴ级,神经功能ASIA分级均达到E级;3例仍存在排尿困难、便秘、胸腰背痛等症状,双下肢疼痛部分缓解,双下肢肌力恢复至Ⅲ、Ⅳ级,神经功能ASIA分级均达到D级。5例行后路长节段椎弓根钉棒内固定者未见内固定松动。结论胸腰椎骨质疏松性压缩骨折行PVP或PKP术后并发骨水泥椎管内渗漏致脊髓损伤症状,应尽早行后方减压、骨水泥取出,可选择性使用后路长节段内固定,临床疗效满意。
Objective To investigate the clinical effect of posterior revision surgery on spinal cord injury caused by intraspinal cement leakage after percutaneous vertebroplasty(PVP)or percutaneous kyphoplasty(PKP)for osteoporotic compression fractures of the thoracolumbar spine.Methods Eight patients who were suffered from spinal cord injuries caused by intraspinal cement leakage after PVP or PKP for thoracolumbar osteoporotic compression fractures,were treated by posterior revision surgery,5 cases of whom underwent posterior long-segment pedicle screw-rod internal fixation;3 patients underwent simple posterior subtotal laminectomy for decompression.The remission of clinical symptoms,the recovery of muscle strength of lower limbs and neurological function recovery were observed.Results All patients were followed up for 7~26 months.At the last follow-up,clinical symptoms were relieved in 5 cases,muscle strength of double lower extremities had returned to gradeⅤ,all ASIA classfication of neurological function reached grade E;3 patients still had dysuria,constipation,pain of chest,waist and back and other symptoms,pain in double lower extremities was partially relieved,the muscle strength of lower limbs were restored to gradeⅢ,Ⅳ,all ASIA classfication of neurological function achieved grade D.No loosening of posterior long-segment pedicle screw-rod fixation was observed in 5 patients.Conclusions For the symptoms of spinal cord injury caused by intraspinal cement leakage after PVP or PKP for osteoporotic compression fracture of thoracolumbar spine,decompression and bone cement removal should be done as soon as possible,the long-segment internal fixation can be selected,and the clinical effect is satisfactory.
作者
马明
崔后春
MA Ming;CUI Hou-chun(Dept of Orthopaedics,the Affiliated Hospital of Yangzhou University,Yangzhou,Jiangsu 225000,China)
出处
《临床骨科杂志》
2020年第6期781-784,共4页
Journal of Clinical Orthopaedics
关键词
胸腰椎骨质疏松性骨折
椎体成形术
骨水泥渗漏
脊髓损伤
后路翻修
thoracolumbar spine osteoporotic fractures
vertebroplasty
cement leakage
spinal cord injuries
posterior revision
