两种方式治疗骨质疏松性胸腰椎爆裂骨折的疗效比较  

Comparison of clinical effects between two kinds of operation methods for osteoportic thoracolumbar burst fracture

作　　者：荚龙 高如峰 付文芹 陈农 陈铭吉 JIA Long;GAO Ru-feng;FU Wen-qin;CHEN Nong;CHEN Ming-ji(Dept of Orthopaedics,Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University,Shanghai 201700,China)

机构地区：[1]复旦大学附属中山医院青浦分院骨科,上海201700

出　　处：《临床骨科杂志》2024年第4期461-465,共5页Journal of Clinical Orthopaedics

摘　　要：目的比较经皮短节段椎弓根螺钉复位内固定术与经皮短节段椎弓根螺钉复位内固定联合经皮椎体成形术治疗骨质疏松性胸腰椎爆裂骨折的临床效果。方法将46例骨质疏松性胸腰椎爆裂骨折患者根据治疗方法不同分为A组(采用经皮短节段椎弓根螺钉复位内固定术治疗,25例)和B组(采用经皮短节段椎弓根螺钉复位内固定联合经皮椎体成形术治疗,21例)。记录两组手术时间、术中出血量、术后下床时间、并发症发生情况、疼痛VAS评分、椎体高度压缩率和Cobb角。结果患者均获得随访,时间12~23(15.80±2.64)个月。手术时间A组短于B组(P<0.05)。术中出血量两组比较差异无统计学意义(P>0.05)。术后下床时间A组长于B组(P<0.05)。B组发生4例骨水泥渗漏。疼痛VAS评分:术后1周B组低于A组(P<0.05);末次随访时两组比较差异无统计学意义(P>0.05)。椎体高度压缩率、Cobb角:两组术后1周及末次随访时均较术前改善(P<0.05);末次随访时B组均优于A组(P<0.05)。结论相较于经皮短节段椎弓根螺钉复位内固定,经皮短节段椎弓根螺钉复位内固定联合经皮椎体成形术治疗骨质疏松性胸腰椎爆裂骨折能够更快地缓解患者疼痛、缩短患者下床时间、更好地维持伤椎高度,但存在骨水泥渗漏的风险。Objective To compare clinical effects between transpedicular screw fixation and transpedicular screw fixation plus percutaneous vertebroplasty for treatment of osteoportic thoracolumbar burst fracture.Methods The 46 patients with osteoportic thoracolumbar burst fracture received surgical treatments were retrospectively analyzed in this research,25 patients underwent transpedicular screw fixation(group A),21 patients were reconstructed with transpedicular screw fixation plus percutaneous vertebroplasty(group B).Operating time,intraoperative bleeding,postoperative time out of bed,occurrence of complications,pain VAS,vertebral height compression rate and Cobb angle were recorded in both groups.Results Patients were followed for 12~23(15.80±2.64)months.Operating time was shorter in group A than group B(P<0.05).Intraoperative bleeding was not statistically different between groups(P>0.05).Postoperative time out of bed was longer in group A than that in group B(P<0.05).Bone cement leakage occurred in 4 patients of group B.Pain VAS were lower in group B than that in group A at 1 week postoperatively(P<0.05),and there was no statistical significance between two groups at final follow-up(P>0.05).Compared with the preoperative period,vertebral height compression rate and Cobb angle were improved in both groups at 1 week postoperatively and at last follow-up(P<0.05);group B was better than group A at last follow-up(P<0.05).Conclusions Compared with percutaneous pedicle screw internal fixation,transpedicular screw fixation plus percutaneous vertebroplasty for osteoporotic thoracolumbar burst fractures can reduce patient pain,shorten patient bedtime,and preserve injured vertebral height,but there is a risk of cement leakage.

关 键 词：骨质疏松 脊柱骨折 椎弓根螺钉内固定 经皮椎体成形术 

分 类 号：R681[医药卫生—骨科学] R683.2[医药卫生—外科学] R687.32[医药卫生—临床医学]