伤椎骨水泥强化与伤椎置钉分别联合椎弓根螺钉治疗骨质疏松性压缩骨折的临床比较  

Clinical comparative study on injured vertebrae bone cement reinforcement and injured vertebral nail placement combined with pedicle screws in the treatment of osteoporotic compression fractures

作　　者：陈阳[1] 宋长福[1] 段野 岳明[1] Chen Yang;Song Changfu;Duan Ye;Yue Ming(Department of Orthopaedics,Shenyang Fifth People’s Hospital,Shenyang 110023,China)

机构地区：[1]沈阳市第五人民医院骨科,辽宁沈阳110023

出　　处：《创伤外科杂志》2021年第3期166-172,共7页Journal of Traumatic Surgery

基　　金：2017年辽宁省自然科学基金指导计划(20170269)。

摘　　要：目的探讨伤椎骨水泥强化与伤椎置钉分别联合椎弓根螺钉治疗骨质疏松性压缩骨折(OVCF)的临床疗效。方法前瞻性选择2016年1月—2017年12月沈阳市第五人民医院骨科收治的OVCF患者82例,随机分为经伤椎置钉组(采用经伤椎置钉椎弓根螺钉固定)和骨水泥强化组(伤椎采用骨水泥强化、椎弓根螺钉固定),各41例。男性28例,女性54例;年龄63~82岁,平均72.1岁。道路交通伤16例,摔伤55例,其他11例。比较两组患者围手术期手术相关指标、影像学指标、脊柱功能康复指标及生活质量,记录术后并发症发生情况。结果伤椎置钉组手术时间少于骨水泥强化组(84.7±15.6)min vs.(96.2±18.7)min,P<0.05,而骨水泥强化组术中出血量、术后下地活动时间及住院时间少于伤椎置钉组(43.7±5.7)mL vs.(57.3±6.4)mL,(1.6±0.7)d vs.(4.2±1.2)d,(10.0±3.4)d vs.(16.6±2.5)d;P<0.05;两组患者术前椎体前缘高度比值、Cobb角、脊柱功能障碍指数(ODI)、视觉模拟评分(VAS)、日常生活能力量表(ADL)评分,术后6个月伤椎前缘高度比值及Cobb角,术后6个月及末次随访(末次随访时间为2019年12月)VAS比较差异无统计学意义(P>0.05);末次随访时骨水泥强化组伤椎前缘高度比高于伤椎置钉组,Cobb角小于伤椎置钉组(88.3±8.1)%vs.(81.7±7.8)%,(7.7±2.8)°vs.(9.2±2.9)°;P<0.05。术后6个月、末次随访时骨水泥强化组ODI低于伤椎置钉组,ADL评分高于伤椎置钉组ODI(29.8±5.4)分vs.(33.4±4.6)分,(20.8±3.2)分vs.(29.9±3.8)分;ADL(71.2±8.7)分vs.(65.2±8.2)分,(82.4±9.3)分vs.(73.3±8.7)分;P<0.05。术后随访6~24个月,伤椎置钉组出现邻近椎体骨折2例,螺钉松动3例,并发症发生率12.20%(5/41);骨水泥强化组出现骨水泥渗漏至椎旁软组织2例,未见临床症状,并发症发生率4.88%(2/41)。两组患者术后并发症发生率比较差异无统计学意义(P>0.05)。结论骨水泥强化联合椎弓根螺钉与伤椎置钉联合椎弓根螺钉均是治�Objective To explore the clinical effect of bone cement reinforcement and injured vertebral nail placement combined with pedicle screws in the treatment of osteoporotic compression fractures(OVCF).Methods From Jan.2016 to Dec.2017,82 patients with OVCF were perspectively selected as research objects,and were randomly divided into the injured vertebral nailing group(pedicle screw fixation with injured vertebra screw fixation)and the bone cement reinforced group(injured vertebrae were strengthened with bone cement,and the pedicle screw fixation),with 41 cases in each group.There were 28 males and 54 females aged 63-82(72.1 on average)years.There were 16 cases of road traffic injuries,55 cases of falling injuries,and 11 cases of other injuries.The perioperative related indexes,imaging indexes,functional rehabilitation indexes and quality of life of the two groups of patients were compared.Results The operation time of the injured vertebra nailing group was less than that of the bone cement reinforced group[(84.7±15.6)minutes vs.(96.2±18.7)minutes,P<0.05],while the intraoperative blood loss,postoperative ground movement time and hospitalization time of the bone cemented reinforced group were less than those in the injured vertebral nailing group[(43.7±5.7)mL vs.(57.3±6.4)mL;(1.6±0.7)days vs.(4.2±1.2)days;(10.0±3.4)days vs.(16.6±2.5)days;P<0.05].There was no statistical difference in the preoperative fractured vertebral anterior height ratio,Cobb’s angle,Oswestry disability index(ODI),visual analogue scale(VAS),and daily living ability scale(ADL)scores between the two groups.Also,the postoperative fractured vertebral anterior height ratio and Cobb’s angle at 6 months after operation,and VAS at 6 months after operation and at the last follow-up(the last follow-up was conducted in December 2019)showed no statistically significant difference(P>0.05).At the last follow-up,the fractured vertebral anterior height ratio in the bone cement reinforced group was higher than that in the injured vertebral nailing grou

关 键 词：骨质疏松性压缩骨折 椎弓根 骨水泥 内固定 

分 类 号：R683.2[医药卫生—骨科学]