后路短节段内固定结合伤椎强化技术治疗骨质疏松性胸腰椎爆裂性骨折  

Posterior Short-segmental Pedicle Screw Fixation Combined With Injured Vertebral Augmentation in the Treatment of Osteoporotic Thoracolumber Burst Fractures

作　　者：陈孜[1] 赵国辉[1] 金丹杰[1] 丁寅 张云坤[1] 徐南伟[1] Chen Zi;Zhao Guohui;Jin Danjie(Department of Orthopedics,Changzhou Second People’s Hospital Affiliated to Nanjing Medical University,Changzhou 213100,China)

机构地区：[1]南京医科大学附属常州市第二人民医院骨科

出　　处：《中国微创外科杂志》2019年第12期1088-1091,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的 探讨后路短节段椎弓根螺钉内固定结合伤椎强化技术治疗骨质疏松性胸腰椎爆裂性骨折的临床效果。方法 对我院2013年1月~2018年2月骨质疏松性胸腰椎爆裂性骨折的临床资料进行回顾性分析,采用短节段椎弓根螺钉固定联合骨水泥强化治疗36例(A组),经皮椎体后凸成形术(percutaneous kyphoplasty,PKP) 35例(B组)。比较2组手术情况;采用视觉模拟评分(Visual Analogue Scale,VAS)和日本骨科学会(Japanese Orthopaedic Association,JOA)评分评估疼痛及功能恢复程度;比较2组伤椎前后缘高度及伤椎矢状面Cobb角变化。结果 与B组比较,A组手术时间长[(86. 0±8. 1) min vs.(34. 3±6. 1) min,t=30. 364,P=0. 000],术中出血多[(48. 5±8. 9) ml vs.(13. 0±3. 3) ml,t=22. 286,P=0. 000],但术后1周VAS评分低[(2. 2±0. 6)分vs.(2. 9±0. 9)分,t=-3. 982,P=0. 000],JOA评分高[(23. 6±2. 5)分vs.(21. 7±2. 1)分,t=3. 573,P=0. 001],椎体前缘高度压缩恢复率高[(87. 2±6. 3)%vs.(77. 9±3. 6)%,t=7. 714,P=0. 000],椎体后缘高度压缩恢复率高[(90. 1±3. 8)%vs.(82. 7±6. 2)%,t=6. 031,P=0. 000],Cobb角小(3. 2°±0. 9°vs. 8. 7°±2. 0°,t=-14. 813,P=0. 000)。结论 与PKP比较,后路短节段椎弓根螺钉内固定结合骨水泥伤椎强化技术可以更好地矫正后凸畸形,恢复伤椎高度,缓解疼痛,改善脊柱功能。Objective To explore the clinical effects of posterior short-segmental pedicle screw fixation combined with injured vertebral augmentation in the treatment of osteoporotic thoracolumber burst fractures.Methods A retrospective analysis was performed on clinical data of patients with osteoporotic thoracolumber burst fractures between January 2013 and February 2018.Among them,36 cases(group A)were treated with posterior short-segmental pedicle screw fixation combined with injured vertebral augmentation,while 35 cases(group B)were treated with percutaneous kyphoplasty(PKP).The surgical outcomes were compared between two groups.The pain degree and functional recovery degree were assessed by using the Visual Analogue Scale(VAS)and Japanese Orthopaedic Association(JOA)scores.The height of the anterior edge and posterior edge and Cobb angle were compared between the two groups.Results As compared with the group B,the group A had longer time of operation[(86.0±8.1)min vs.(34.3±6.1)min,t=30.364,P=0.000],more intraoperative bleeding volume[(48.5±8.9)ml vs.(13.0±3.3)ml,t=22.286,P=0.000],lower VAS scores[(2.2±0.6)points vs.(2.9±0.9)points,t=-3.982,P=0.000],higher JOA scores[(23.6±2.5)points vs.(21.7±2.1)points,t=3.573,P=0.001],higher height restoring rate of the anterior edge[(87.2±6.3)%vs.(77.9±3.6)%,t=7.714,P=0.000]and posterior edge[(90.1±3.8)%vs.(82.7±6.2)%,t=6.031,P=0.000],and lower Cobb angle(3.2°±0.9°vs.8.7°±2.0°,t=-14.813,P=0.000)at one week after operation.Conclusion As compared with PKP,posterior short-segmental pedicle screw fixation combined with injured vertebral augmentation is more effective in correcting patients’kyphosis,restoring the injured vertebral height,relieving pain and improving spinal functions.

关 键 词：骨质疏松 胸腰椎爆裂性骨折 椎弓根螺钉固定 骨水泥强化 经皮椎体后凸成形术 内固定 

分 类 号：R68[医药卫生—骨科学]