短节段经皮椎弓根螺钉固定联合自固化磷酸钙人工骨植骨治疗胸腰椎单椎体骨折35例疗效观察

Curative effect observation on 35 cases of short-segment percutaneous pedicle screw fixation combined with calcium phosphate cement artificial bone grafting to treat thoracolumbar single vertebra fracture

目的观察短节段经皮椎弓根螺钉固定联合自固化磷酸钙人工骨植骨治疗无神经损伤的胸腰椎单椎体骨折的临床疗效。方法选取无神经损伤的胸腰椎单椎体骨折(Load-sharing评分≤6分)患者35例,通过短节段经皮椎弓根螺钉固定及在伤椎内经椎弓根注入自固化磷酸钙人工骨治疗。记录患者的手术时间、术中出血量,术后随访6个月,比较术前、术后1周、末次随访时患者的视觉模拟评分法(VAS)评分,矢状面Cobb角,椎体前、后缘高度压缩率。结果35例患者均获得随访,手术时间80~100 min,平均(92.4±5.8)min;术中出血量80~95 m L,平均(88.3±6.4)m L。与术前比较,术后1周及末次随访时患者VAS评分,椎体前、后缘高度压缩率均明显降低,Cobb角明显缩小,差异均有统计学意义(P<0.05)。结论采用短节段经皮椎弓根螺钉固定联合自固化磷酸钙人工骨植骨治疗无神经损伤的胸腰椎单椎体骨折临床疗效显著,能明显减轻患者疼痛,降低椎体高度压缩率,增加椎体稳定性,且可减少术中出血量,值得临床推广应用。

Objective To observe the clinical efficacy on short-segment percutaneous pedicle screw fixation combined with calcium phosphate cement(CPC)artificial bone grafting to treat thoracolumbar single vertebra fracture without nerve damage.Methods Thirty-five cases of thoracolumbar single vertebral fracture without nerve damage(Load-sharing score≤6)were chosen,and they were treated by short-segment percutaneous pedicle screw fixation combined with transpedicular injection of CPC artificial bone into injured vertebra.The operation time and intraoperative blood loss were recorded.The patients were followed up for 6 months.The visual analogue scale(VAS)score,Cobb angle of sagittal plane,the height compression rate of anterior and posterior border of vertebral body were compared before operation,1 week after operation and the last follow-up.Results All 35 patients were followed up,the operation time was 80 to 100 min,with an average of(92.4±5.8)min;the intraoperative blood loss was 80 to 95 m L,with an average of(88.3±6.4)m L.Compared with those before operation,VAS score,the height compression rate of anterior and posterior border of vertebral body all significantly decreased,Cobb angle significantly reduced in the patients of 1 week after operation and of the last follow-up,and the difference was statistically significant(P<0.05).Conclusion It has marked clinical curative effects,can markedly alleviate the pains of the patients,decrease the height compression rate of anterior and posterior border of vertebral body and increase the stability of the vertebral body,along with reducing the intraoperative blood loss to use short-segment percutaneous pedicle screw fixation combined with CPC artificial bone grafting to treat thoracolumbar single vertebra fracture without nerve damage,which deserves clinical promotion and application.