标题：骨质疏松性椎体压缩骨折合并腰椎退行性病变的治疗方法及其疗效观察

      作者：余伟民 1，赵建利 1，秦有智 1，王立松 2
    （1.商洛市第二人民医院骨科，陕西 商洛 726000；
2.商洛市中心医院，陕西 商洛 726000）

      卷次： 2014年25卷7期

      【摘要】 目的 探讨一期椎体后外侧融合(Posterolateral fusion，PLF)结合伤椎椎体后凸成形术(Percutane-
ous kyphoplasty，PKP)治疗骨质疏松性椎体压缩骨折(Osteoporotic vertebral compression fractures，OVCF)合并腰
椎退行性变（Lumbar degenerative diseases，LDD）的临床疗效。方法 回顾性分析2008年3月至2010年9月期间
在我科因OVCF合并LDD行一期后路PLF+PKP联合手术的86例患者。术前、术后随访时定期拍摄脊柱正侧位
x线片，测量椎体前缘、中部高度以及后凸角（Cobb角）的变化；采用 JOA评分标准，评估患者腰背痛及神经功能
改善情况；采用活动能力的评分评估患者术后活动能力情况。结果 患者术后3个月椎体前缘及中部高度均高
于术前(P<0.05)。术后3个月Cobb角角度[(15.8±4.71)°]小于术前[(28.3±7.45)°]，差异有统计学意义(P<0.05)。患
者椎体前缘、中部高度及Cobb角末次随访时与术后3个月时比较差异无统计学意义(P>0.05)。患者 JOA评分术
后3个月时[(23.62±4.60)分]明显高于术前[(10.85±4.26)分]，差异有统计学意义(P<0.05)；末次随访时略高于术后3
个月时，差异有统计学意义(P<0.05)。患者活动能力评分术后3个月时[(1.22±0.38)分]明显低于术前[(2.57±0.43)
分]，差异有统计学意义(P<0.05)；末次随访时略低于术后3个月时(P<0.05)。结论 采用PLF+PKP手术方式治疗
OVCF合并LDD安全可行，能够迅速缓解疼痛，恢复脊柱的形态，在临床上切实可行。

      【关键词】 骨质疏松性椎体压缩骨折；腰椎退行性病变；椎体后凸成形术；椎体融合术

      【中图分类号】 R683.2 【文献标识码】 A 【文章编号】 1003—6350（2014）07—0969—03


Treatment strategy and efficacy observation for osteoporotic vertebral compression fractures combined with
lumbar degenerative diseases.
YU Wei-min 1, ZHAO Jian-li 1, QIN You-zhi 1, WANG Li-song 2. 1. Department of
Orthopedics, The Second People's Hospital of Shangluo, Shangluo 726000, Shaanxi, CHINA; 2. Central Hospital of
Shangluo, Shangluo 726000, Shaanxi, CHINA

【Abstract】 Objective To investigate the efficacy of percutaneous kyphoplasty (PKP) and posterolateral fu-
sion (PLF) for the treatment of osteoporotic vertebral compression fractures (OVCF) combined with lumbar degenera-
tive diseases (LDD). Methods Eighty-six cases underwent PLF combined with PKP operation had been followed-up
from March 2008 to September 2010．The vertebral bodies height and Cobb angle were measured and evaluated at
preoperative and postoperative follow-up by analysing results of X-ray of spine. Low back pain and nerve function re-
covery were assessed using JOA score. Locomotor activity was assessed using locomotor activity scale. Results The
height of anterior edge vertebral body and central vertebral body 3 months after surgery were respectively higher than
those before operation (P<0.05). Cobb angle of (15.8±4.71) ° in 3 months after surgery was less than (28.3±7.45) ° be-
fore operation (P<0.05). There was no statistically significant difference of the height of anterior edge, central verte-
bral body and Cobb angle between 3 months after surgery and the finial follow-up. The JOA scores of (23.62±4.60) 3
months after surgery were significantly higher than (10.85±4.26) of preoperative (P<0.05). And, the scores of locomo-
tor activity in 3 months after surgery (1.22±0.38) ° were significantly lower than those of preoperative (2.57±0.43) °
(P<0.05). The nerve function recovery and locomotor activity were slightly improved in the final follow-up when com-
pared with those of 3 months after surgery (P<0.05). Conclusion PKP and PLF is safe, feasible and effective for the
treatment of OVCF combined with LDD, which can quickly relieve pain and restore the spine morphology.

      【Key words】 Osteoporotic vertebral compression fracture; Lumbar degenerative disease; Percutaneous kypho-