经皮椎弓根螺钉固定结合伤椎成形术治疗骨质疏松性胸腰椎骨折疗效分析  

作　　者：林伟龙[1] 蓝芳[1] 林勇[1] 

机构地区：[1]浙江省丽水市中医院,323000

出　　处：《浙江临床医学》2018年第9期1514-1515,共2页Zhejiang Clinical Medical Journal

摘　　要：目的探讨经皮椎弓根螺钉固定结合伤椎成形术治疗骨质疏松性胸腰椎骨折疗效。方法2012年1月至2015年1月采用经皮后路椎弓根螺钉内固定结合伤椎强化术治疗无神经损伤表现骨质疏松性胸腰椎骨折患者38例。根据术前和术后伤椎前缘高度比、矢状面Cobb角、oswes州功能障碍指数（ODI）及随访期间固定失败情况等进行评价。结果所有患者获得随访，时间18-36个月，平均（225±6．4）个月。手术时间40～80min，平均（60．2±27．8）min；术中出血量40~80ml，平均（65．2±225）ml。伤椎前缘高度比由术前（522±36）％改善至术后1周（90．4±2．2）％及末次随访的（89．6±28）％；伤椎矢状面Cobb角由术前（30．2±43）°改善至术后1周的（7．1±12）°及末次随访的（7．8±1.3）°；ODI评分由术前（6612±271）分改善至术后1周的（2272±3．14）分及末次随访的（2455±3．74）分。与术前比较，术后1周及末次随访伤椎前缘高度比、矢状面Cobb角、ODI平分差异均有统计学意义（P〈005）；术后1周与末次随访时比较，伤椎前缘高度比、OD｜、矢状面cobb角差异均无统计学意义（P〉0．05）。无神经功能损伤、内固定失败情况及后凸畸形再发。结论经皮后路短节段椎弓根螺钉固定结合伤椎骨水泥成形术可恢复伤椎高度，改善后凸畸形，是治疗中老年胸腰椎骨质疏松性骨折安全、可靠的微创方法。Objective To evaluate medium term efficacy ofpercutaneous pedicle screw fixation combined with augmentation vertebroplasty in treatment of thoracolumbar osteoporotic fracture in elderly patients. Methods From January 2012 to January 2015, 38 cases of non--neurological symptom patients with thoracolumbar osteoporotic fracture were included and given pedicle screw fixation combined with augmentation vertebroplasty in the study. The anterior vertebral body height, the saglttal Cobb angle, Oswestry Disability Index （ ODI ） and internal fixation failure were included in the assessment. Results All patients were followed up for 18-36 months, with an average of （ 22.5 ±6.4 ） months. The operation time was 40~80~nin, with an average of （ 60.2±27.8 ） rain, and the intraoperative blood loss was 40~80ml, with an average of （ 65.2 ± 22.5 ） hal. The height of the anterior edge of the injured vertebra was improved from （ 52.2 ± 3.6 ） %, to 1 weeks （ 90.4 ± 2.2 ） % and at the last follow-up （ 89.6 ± 2.8 ） %. The ODI score improved from preoperative （ 66.12 ± 2.71 ） to 1 week （ 22.72± 3.14 ） and at the last follow-up （ 24.55 ± 3.74 ） . Compared with preoperative, there were significant differences in height ratio, sagittal Cobb angle and ODI bisection between the 1 week and the hst follow-up （P〈0.05） . No neurological impairment, failure of internal fixation and kyphosis recurrence occurred after operation. Conclusion Percutaneous pedicle screw fixation combine with vertebroplasty can restore the height of injured vertebrae, correct kyphotic defomtity. It is a safe and reliable minimally invasive and effective procedure for treatment ofthoracolumbar osteoporotic fracture.

关 键 词：脊柱骨折 椎弓根螺钉 椎体成形 

分 类 号：R683[医药卫生—骨科学]