膨胀与普通椎弓根钉治疗脊柱胸腰段骨折合并骨质疏松的对比研究

Comparison between expansive and common pedicle screws system in treatment of fractures of thoracolumbar vertebrae in patients with osteoporosis

目的 比较膨胀椎弓根螺钉系统与普通椎弓根螺钉系统在治疗合并骨质疏松的脊柱胸腰段骨折中的临床疗效，特别是二者在恢复及维持胸腰椎高度、生理曲度方面的应用效果。方法 我院自2002年2月至2004年2月临床诊断为脊柱胸腰段骨折合并骨质疏松，经后路行复位、椎弓根系统内固定病例获随访48例，其中应用膨胀椎弓根螺钉系统治疗22例（A组），应用普通椎弓根螺钉系统治疗26例（B组），观察复位、固定及骨折愈合情况，测量术前及术后随访的椎体前缘压缩率、矢状面后凸Cobb角。结果 全部48例患者经平均15．2个月（12～20个月）随访，骨折均愈合，未发现内植物并发症。平均愈合时间：A组（2．8±0．8）月，B组（3．0±1．1）月，差异无显著性（P〉0．05）。A组术前椎体前缘压缩率、后凸Cobb角均值分别为（47．1±11．6）％、（23．2±5．1）°；术后随访矫正为（93．6±5．7）％、（5．2±2．7）°；B组术前椎体前缘压缩率、后凸Cobb角均值分别为（45．8±12．1）％、（22．5±6．7）°；术后随访矫正为（80．2±8．3）％、（8．6±2．9）°。各组内术前与术后随访的椎体前缘压缩率、Cobb角差异均显著（P〈0．05）。A、B组间术前的椎体前缘压缩率、Cobb角差异均无显著性（P〉0．05）；A、B组间术后随访的椎体前缘压缩率、Cobb角差异均有显著性（P〈0．05）。结论 对于脊柱胸腰段骨折合并骨质疏松病例，采用膨胀椎弓根螺钉内固定系统在恢复、维持胸腰椎高度及生理曲度方面优于普通椎弓根螺钉系统，但二者在骨折愈合时间方面差异无显著性。

Objective To compare the clinical effects between expansive and common pedicle screws system in treatment of fractures of thoracolumbar vertebrae in patients with osteoporosis. Methods Fourty-eight cases of fractures of thoracolumbar vertebrae with osteoporosis treated with internal fixator system of pedicle screws from February 2002 to February 2004 were included. Group A consisted of 22 cases treated with expansive pedicle screws and Group B consisted of 26 cases with common pedicle screws. The fracture restorations, vertebral compression rates and Cobb＇s angle of pre and post-operation were reviewed.Results All cases were reviewed and the fracture healed within 12-20 months（mean 15.2 months）. No symptoms of internal fixators was shown. There were no significant differences in the duration of healing between group A（2.8 ± 0.8 months） and B（3.0 ± 1.1 months）（ P 〉0.05）. The mean vertebral compression rate and Cobb＇s angle of group A were （47.1 ± 11.6） %, （23.2 ± 5. 1）°;and （93.6 ± 5.7） %, （5.2 ± 2.7）° when being followed up（ P 〈 0.05, P 〈 0.05） .The results for group B were（45.8 ± 12.1） %, （22.5 ± 6.7）° ;and （80.2 ± 8.3） %, （8.6 ± 2.9）°, respectively. There was no significant difference in vertebral compression rate or Cobb＇s angle between group A and B preoperatively （P 〉 0.05）,but significant difference was found when follow up（ P 〈 0.05）. Conclusions A better restoration can be obtained by using the expansive pedicle screws system than common pedicle screws system in treatment of fractures of thoracolumbar vertebrae with osteoporosis. But there is no significant differences in the duration of healing process.