经皮椎弓根螺钉结合伤椎置钉与骨水泥强化治疗中老年胸腰椎骨质疏松性压缩骨折的疗效比较  

Efficacy comparison of percutaneous pedicle instrumentation combined with vertebral fracture fixation or vertebral augmentation for treatment of osteoporotic thoracolumbar fractures in elderly patients

作　　者：韩雷[1] 全仁夫[1] 孙观荣 李强[1] 胡文跃 田观明[1] 徐金渭[1] 徐建柱[1] 

机构地区：[1]杭州市萧山区中医院骨科,311201

出　　处：《中华创伤杂志》2017年第3期213-218,共6页Chinese Journal of Trauma

基　　金：杭州市卫生科技计划（2014825）;杭州市萧山区重大科技攻关项目（2014208）

摘　　要：目的比较经皮椎弓根螺钉结合伤椎置钉与伤椎骨水泥强化在治疗中老年胸腰椎骨质疏松性胸腰椎压缩骨折（OVCF）的疗效。方法采用回顾性病例对照研究分析2009年1月-2012年1月收治的中老年OVCF患者62例，其中男22例，女30例；年龄55～70岁，平均61．3岁。骨折部位：T11 8例，T12 20例，L1 22例，L2 12例。神经功能按Frankel分级均为E级。根据手术方法分为经皮椎弓根螺钉固定联合伤椎置钉组（A组，36例）和经皮椎弓根螺钉固定联合伤椎骨水泥强化组（B组，26例）。记录两组手术时间、术中出血量，比较两组术前、术后3d、术后1年及末次随访时伤椎前缘高度比、矢状面Cobb角及视觉模拟评分（VAS），观察两组术后并发症情况。结果患者均获随访36—58个月，平均46．5个月。手术时间A组为（82．6±16．2）min，B组为（96．8±20．6）min（P〈0．05）。术中出血量A组为（52．2±15．5）ml，B组为（40．5±10．2）ml，（P〈0．05）。A组术前、术后3d及术后1年伤椎前缘高度比和矢状面Cobb角与B组比较差异均无统计学意义（P〉0．05）。末次随访时B组椎体前缘高度比、矢状面Cobb角[（87．8±2．5）％、（7．8±3．5）°]均优于A组[（82．6±3．2）％、（9．1±1．8）°]（P〈0．05）。术前、术后3d及末次随访时两组VAS差异均无统计学意义（P〉0．05）。B组4例出现骨水泥渗漏。围术期A组3例出现肺部感染，B组1例出现下肢深静脉血栓形成。两组均无内固定失败患者。结论经皮椎弓根螺钉结合伤椎置钉与骨水泥强化均可有效治疗中老年骨质疏松性胸腰椎压缩骨折，但经皮椎弓根螺钉结合伤椎骨水泥强化更有利于维持伤椎前缘高度比和防止后凸畸形复发。Objective To compare the outcomes of percutaneous pedicle instrumentation combined with vertebral augmentation or vertebra pedicle instrumentation for treatment of osteoporotic thoracolumbar fractures （OVCF） in elderly patients. Methods A retrospective case cohort study was conducted on 62 patients with OVCF manifesting non-neurological symptoms treated from January 2009 to January 2012. There were 22 males and 30 females, with a mean age of 61.3 years （ range, 55 to 70 years）. Fracture level was TH in 8 patients, T12in 20, L1 in 22 and L2 in 12. Treatments included percutaneous pedicle instrumentation combined with vertebral fracture fixation in 36 patients （Group A） and percutaneous pedicle instrumentation combined with vertebral augmentation in 26 patients （Group B）. Operation time, intraoperative blood loss, anterior vertebral body height, sagittal Cobb angle and visual analogue score （VAS） were compared between the two groups. Results All patients were followed up for average 46.5 months （ range, 36 to 58 months）. Operation time in Group A [ （ 82.6 ±16.2） mini was shorter than that in Group B [ （96.8 ± 20.6） vain] （ P 〈 0. 05 ）. Blood loss in Group B [ （40.5 ± 10.2） ml] was less than that in Group A [ （52.2 ± 15.5 ） ml ] （ P 〈 0.05 ）. Before operation and 3 days and 1 year after operation, the anterior vertebral body height and sagittal Cobb angle in Group A showed no significant differences compared to Group B （ all P 〉 0.05）. At the final follow-up, the ratio of anterior vertebral height and Cobb angle in Group B [ （ 87.8 ± 2.5 ） %, （7.8 ± 3.5 ） ° ] were better than these in Group A [ （82.6 ± 3.2） %, （9.1 ± 1.8）°] （P 〈 0.05 ）. VAS showed no statistical significance between the two groups before and after operation （ P 〉 0.05 ）. Bone cement leakage was seen in four patients in Group B. During the perioperative period, there were 3 patients with lung infection in Group A and 1 patient with lower limb deep vein thr

关 键 词：骨质疏松性骨折 脊柱骨折 骨折固定术 内 

分 类 号：R687.3[医药卫生—骨科学]