两种固定方式治疗老年胸腰椎爆裂骨折的疗效比较  

Comparison effect of two fixation methods for treatment of elderly thoracolumbar burst fracture

作　　者：邓红平 吴杭钦 程杭冲 徐云 胡灏 傅献勇 董阳昕 王晨 DENG Hong-ping;WU Hang-qin;CHENG Hang-chong;XU Yun;HU Hao;FU Xian-yong;DONG Yang-xin;WANG Chen(Section Ⅱ,Dept of Orthopaedics,the First People's Hospital of Wuyi County,Jinhua,Zhejiang 321200,China)

机构地区：[1]武义县第一人民医院骨二科,浙江金华321200

出　　处：《临床骨科杂志》2023年第6期782-787,共6页Journal of Clinical Orthopaedics

基　　金：浙江省金华市科技局立项课题基金(编号:2022-KY-61)。

摘　　要：目的比较短节段骨水泥强化椎弓根螺钉与长节段普通椎弓根螺钉固定治疗老年胸腰椎爆裂骨折的临床效果。方法将80例老年胸腰椎爆裂骨折患者根据固定方式不同分为A组(40例,采用短节段骨水泥强化椎弓根螺钉固定治疗)和B组(40例,采用长节段普通椎弓根螺钉固定治疗)。记录两组手术情况、伤椎前缘高度丢失率、伤椎Cobb角、疼痛VAS评分及并发症发生情况。结果患者均获得随访,时间10~35个月。手术时间、切口长度、术中出血量A组均短(少)于B组(P<0.01)。疼痛VAS评分:术后4 d B组低于A组(P<0.01);末次随访两组比较差异无统计学意义(P>0.05)。伤椎前缘高度丢失率、伤椎Cobb角:两组术后、末次随访均较术前改善(P<0.05);两组末次随访与术后比较均有所丢失,但A组比较差异无统计学意义(P>0.05),而B组比较差异有统计学意义(P<0.05);两组术后比较差异均无统计学意义(P>0.05);末次随访A组均优于B组(P<0.05)。并发症发生率A组低于B组(P<0.05)。结论与长节段普通椎弓根螺钉相比,后路短节段骨水泥强化椎弓根螺钉固定治疗老年胸腰椎爆裂骨折具有手术切口小、术中出血少、手术时间短、术后椎体高度维持较好、并发症少等优点,但需注意骨水泥渗漏风险。Objective To compare the clinical effects of short-segment cement-augmentation pedicle screw and long-segment common pedicle screw fixation in the treatment of elderly thoracolumbar burst fractures.Methods The 80 elderly patients with thoracolumbar burst fractures were divided into group A(40 cases were treated with short-segment cement-augmentation pedicle screw)and group B(40 cases were treated with long-segment common pedicle screw),according to different fixation methods.The surgical conditions,loss rate of anterior edge height of injured vertebra,Cobb angle of injured vertebra,pain VAS and incidence condition of complications were recorded in the two groups.Results All patients were followed up for 10~35 months.Operation time,incision length and intraoperative blood loss in group A were all shorter(less)than those in group B(P<0.01).Pain VAS:at 4 d after surgery,group B was lower than group A(P<0.01);at the last follow-up,there was no statistical difference between the two groups(P>0.05).The loss rate of anterior edge height of injured vertebra and Cobb angle of injured vertebra:two groups were improved after surgery and at the last follow-up,compared with the preoperation(P<0.05);at the last follow-up,they both had some loss,compared with the postoperation,but group A had no statistical difference(P>0.05),while group B had statistical difference(P<0.05);there were both no statistical differences between two groups(P<0.05);at the last follow-up,the data of group A were both superior to group B(P<0.05).The incidence rate of postoperative complications in group A was lower than that in group B(P<0.05).Conclusions In the treatment of thoracolumbar burst fractures in the elderly,compared with long-segment common pedicle screw,posterior short-segment cement-augmentation pedicle screw fixation has the advantages of smaller incision,less intraoperative bleeding,shorter operation time,better maintenance of postoperative vertebral height and fewer complications.However,the risk of bone cement leakage should be paid a

关 键 词：胸腰椎骨折 椎弓根钉 长节段固定 短节段固定 

分 类 号：R683.2[医药卫生—骨科学] R687.3[医药卫生—外科学]