椎体成形术并椎弓根钉内固定治疗胸腰椎骨折52例

52 Cases of Thoracolumbar Fractures Treated with Vertebroplasty and Pedicle Screw Fixation

目的探讨经伤椎椎弓根硫酸钙骨水泥椎体成形术并后路椎弓根钉内固定术治疗胸腰椎骨折的临床疗效、并发症及对患者生活质量的影响。方法选择52例胸腰椎骨折患者,采用经后路椎弓根钉内固定联合硫酸钙骨水泥椎体成形术治疗。并分别于手术前、术后1周、术后1年取钉时、取钉后1年统计椎体前、中、后缘的椎体高度、后凸畸形角(Cobb角)以及进行Oswestry功能障碍指数(Oswestry Disablity Index,ODI)分级评价。结果术后1周、取钉时和取钉后1年患者椎体高度均较术前明显增加,差异均有统计学意义(P<0.05);其Cobb角均较术前减小,差异均有统计学意义(P<0.05);术后各次随访结果之间比较,差异无统计学意义(P>0.05)。患者术前ODI评价的优良率为5.77%,取内固定术后1年的ODI的优良率为98.08%,两者比较差异有统计学意义(P<0.05)。结论经伤椎椎弓根骨水泥椎体成形术并后路椎弓根钉内固定治疗胸腰椎骨折有效避免了单纯椎弓根螺钉内固定的并发症,且长期疗效肯定,可有效提高患者的日常生活质量。

Objective To explore the clinical efficacy and complications of thoracolumbar fractures and the impacts on life quality in the patients treated with vertebroplasty of vertebral pedicle calcium sulfate cement through the injured vertebras and posterior pedicle screw fixation. Methods Fifty - two cases of tho- racolumbar fractures were collected. The posterior pedicle screw fixation and vertebroplasty of vertebral pedicle calcium sulfate cement were adopted. Separately, before surgery, 1 week after surgery, at the moment of screw removal in 1 year of surgery, 1 year after screw removal, the vertebral heights of the anterior, medium and posterior borders of vertebra and Cobb angle, as well as Oswestry Disability Index （ODI） were assessed statistically. Results The vertebral heights 1 week after surgery, at the moment of screw removal and 1 year after screw removal were increased apparently as compared with those before surgery, indicating the statistically significant difference （P 〈 0.05 ）. Cobb angle was reduced as compared with that before surgery, indicating the statistical significance （P 〈 0.05 ）. In the comparison of follow - up visit results after surgery, the difference was not statistically significant（ P 〉 0.05 ）. The excellent rate was 5.77% in ODI assessment before surgery and that was 98.08 % 1 year after fixation, presenting the statistically significant difference （P 〈 0.05）. Conclusion The vertebroplasty of vertebral pedicle calcium sulfate cement through the injured vertebras and posterior pedicle screw fixation effectively avoid the complications caused by simple pedicle screw fixation in the treatment of thoracolumbar fractures, achieve the definite efficacy and effectively improve the daily life activity of patients.