膨胀式椎弓根螺钉与普通椎弓根螺钉治疗骨质疏松性胸腰段爆裂骨折的疗效分析  

The clinical curative effect of the expandable pedicle screw and conventional pedicle screw fixation for thoracolumbar burst fractures in the senile patients with osteoporosis

作　　者：曹春风[1] 王群波[1] 张铭华[1] 卢旻鹏 霍理 李正云[2] CAO Chun-feng;WANG Qun-bo;ZHANG Ming-hua;LU Min-peng;HUO Li;LI Zheng-yun(Department of Orthopedics,Yongchuan Hospital Affiliated to Chongqing Medical University,Chongqing 402160,China;Department of Orthopedics,People＇s Hospital of Chongqing Banan,Chongqing 401320,China)

机构地区：[1]重庆医科大学附属永川医院骨科,重庆402160 [2]重庆市巴南区人民医院骨科,重庆401320

出　　处：《创伤外科杂志》2018年第6期457-460,共4页Journal of Traumatic Surgery

基　　金：重庆市教委自然科学基金(KJ1500232)

摘　　要：目的评价膨胀式椎弓根螺钉系统与普通椎弓根螺钉系统在治疗合并骨质疏松症的胸腰段爆裂性骨折的临床疗效。方法回顾性分析2009年1月—2011年12月行后路椎弓根钉固定术的51例合并骨质疏松症的胸腰段爆裂性骨折患者,其中应用膨胀钉25例(膨胀钉组),应用普通钉26例(普通钉组)。术后随访并对比观察椎体前后缘高度改善情况、伤椎Cobb角、术前及术后VAS评分、椎弓根螺钉稳定性及脊柱融合情况。结果 51例患者获得术后平均26.5个月的随访,普通钉组中2例患者出现螺钉松动,膨胀钉组未发生螺钉松动。两组患者骨融合良好,两组患者术后椎体前后缘高度、Cobb角矫正、VAS评分均较术前明显改善(P<0.05),且远期随访发现普通钉组椎体高度再丢失高于膨胀钉组(P<0.05)。结论经后路膨胀式椎弓根钉固定治疗合并骨质疏松症的胸腰段爆裂性骨折在促进骨折愈合、改善疼痛及减少术后后凸畸形方面均具有良好的临床疗效,且较之普通椎弓根螺钉固定在骨质疏松椎体中具有更好的稳定性,更能维持骨折椎体高度及脊柱后凸Cobb角。Objective To explore the clinical curative effect of the expandable pedicle screw（ EPS） and conventional pedicle screw system fixation for thoracolumbar burst fractures in the senile patients with osteoporosis.Methods Fifty-one cases of fractures of thoracolumbar vertebrae with osteoporosis treated with internal fixator system of expansive pedicle screws and common pedicle screws from Jan. 2009 to Dec. 2011 were included. Group A consisted of 25 cases treated with expansive pedicle screws and group B consisted of 26 cases with common pedicle screws. The improvement of the height of the front and back edge of the centrum,Cobb angle of the centrum,VAS score,the stability of the pedicle screw and the spine fusion were reviewed. And the index above between group A and group B were observed and compared. Results All cases were reviewed for an average of 26. 5 months. Bolt loosening was observed in 2 patients of group B while no patient in group A,and the bolt loosening rate of group A was significantly lower than that in group B（ P 0. 05）. The spine fusion was good in both group A and group B and significant improvement of the height of the front and back edge of the centrum,Cobb angle,VAS score was observed in group A and group B,respectively（ P 0. 05）. The loss of the height of centrum in group B was higher than that in group A during the long follow-up period（ P 0. 05）. Conclusion The clinical effects in promoting fracture healing,improving mean pain and reducing the kyphosis are very good after using the expansive pedicle screws system to treat fractures of thoracolumbar vertebrae in patients with osteoporosis. In addition,the stability and the ability of keeping the height of centrum and Cobb angle are better than common pedicle screws.

关 键 词：胸腰椎爆裂骨折 椎弓根 螺钉系统 骨质疏松 

分 类 号：R681.5[医药卫生—骨科学]