伤椎置钉联合可注射硫酸钙治疗围绝经期胸腰椎骨折的疗效分析  

Efficacy analysis of intermediate screws technique plus injectable calcium sulfate for thoracolumbar fracture in postmenopausal patients

作　　者：于研[1] 曾至立[1] 李山珠[2] 贾永伟[1] 荚龙[1] 王建杰[1] 吴周睿[1] 胡笑[1] 徐委[1] Sujan Maharjan 程黎明[1] 

机构地区：[1]同济大学附属同济医院脊柱外科,上海200065 [2]新疆医科大学第二附属医院骨科

出　　处：《中华医学杂志》2013年第45期3582-3585,共4页National Medical Journal of China

基　　金：国家自然科学基金（30973034）;新疆维吾尔自治区科技支疆项目（201233148）

摘　　要：目的 探讨伤椎置钉联合可注射硫酸钙（MIIG）治疗围绝经期胸腰椎骨折的临床疗效.方法 回顾性分析2009年4月至2013年5月同济大学附属同济医院脊柱外科21例围绝经期胸腰椎骨折患者,联合伤椎置钉后路内固定及MIIG前路椎体增强的三维重建术式,比较术后伤椎椎体高度和Cobb角度变化情况,以疼痛视觉模拟评分（VAS）评估患者自觉症状的改变,并随访观察.结果 21例患者经伤椎置钉内固定和MIIGX3手术治疗后成功治愈,平均填充量为4.6 ml.术中渗漏者2例,无严重并发症.患者均获得随访,时间为6～36个月,平均15个月,VAS评分系统显示疼痛症状明显缓解（术前VAS评分平均为7.8分,术后VAS评分平均为2.2分）,伤椎椎体高度和Cobb角较术前明显改善,术前分别为45.0%±6.4%和（19.4±4.5）°,末次随访分别为15.4 %±3.9%和（8.7±3.2）°.除2例椎体高度丢失12%外,其余椎体高度平均恢复达正常的85%.结论 围绝经期患者的骨折伤椎,经伤椎置钉联合MIIG的手术治疗,可达到安全有效、复位满意、稳定持久的临床疗效.Objective To explore the clinical efficacies of intermediate screws plus injectable calcium sulfate MIIGX3 for thoracolumbar fracture in postmenopausal patients. Methods A total of 21 postmenopausal patients with vertebral compression fractures reconstructed with posterior internal fixation of intermediate screws technique and anterior vertebral augmentation of MIIGX3 technique in three dimension were retrospectively analyzed. The changes of fracture vertebral height and Cobb＇ s angle were compared. Visual analogue scale （VAS） was performed to evaluate their symptoms. All patients were followed up. Results Intermediate screws surgical technique plus MIIGX3 was successfully performed. The average injection dose was 4. 6 ml. Leakage occurred intraoperatively in two cases. The average follow-up period was 15 （6- 36） months. The VAS system demonstrated that pain decreased significantly （preoperative：7. 8, postoperative：2. 2）. The height and Cobb＇s angle of fractured vertebra improved greatly. The preoperative values were 45.0 ±6.4% and 19.4 ±4.5° and postoperative ones 15.4 ± 3.9% and 8.64 ± 3.18° respectively. There was no occurrence of severe complications related with treatment.Except for 2 patients with a loss of 15% of vertebral height, the average heights of fractured vertebra in other 19 patients recovered to 85% of normal ones. Conclusion Thoracolumbar fracture in postmenopausal patients may be managed satisfactorily by intermediate screws and injectable calcium sulfate technique. Such a technique is both safe and effective. And its stable and durable reduction offers significant improvement.

关 键 词：脊柱骨折 骨钉 硫酸钙 绝经后期 

分 类 号：R687.3[医药卫生—骨科学]