脊柱微创手术对骨质疏松性椎体骨折的疗效及安全性分析

Efficacy and Safety of Minimally Invasive Spine Operation of Osteoporotic Vertebral Fracturesw

目的:探究脊柱微创手术对骨质疏松性椎体骨折的疗效及安全性。方法:选取我院骨科于2008年3月-2011年3月收治的72例骨质疏松性椎体压缩骨折进行分组治疗,观察组(n=36)接受脊柱微创手术,对照组(n=36)接受传统保守治疗,对比两组患者术后生活情况、疗效及观察组术后并发症。结果:两组患者治疗前压缩椎体高度/病椎上下椎体高度和之半、椎体后凸Cobb角及骨块侵占椎管比率无明显统计学差异(P>0.05),治疗后上述指标均显著改善,观察组改善程度较对照组更为明显(P<0.05);观察组治疗优良率91.7%,对照组为58.3%,其中6例患者因症状加重转为手术治疗,观察组治疗效果明显优于对照组(P<0.05);观察组患者术后未出现内植物松动、断裂、形成假关节、截瘫等并发症,钉棒内固定系统坚强可靠;两组患者均获得有效随访,平均随访时间(9.7±2.5)个月,观察组平均下地时间(4.1±1.7)d,肌力恢复时间(3.7±0.8)周,Frankel神经功能均恢复E级;对照组平均下地时间(7.4±3.0)d,肌力恢复时间(5.9±1.4)周,Frankel神经功能评分:D级6例,E级30例。结论:脊柱微创手术能够有效改善骨质疏松性椎体骨折患者骨骼力学变化,可有效保证其术后恢复情况,疗效较好,且不会引发严重并发症,值得临床广泛推广。

Objective： To explore the efficacy and safety of minimally invasive spine operation of osteoporotic vertebral fractures.Methods： In our department of orthopedics from 2008 March to 2011 March, 72 cases of osteoporotic vertebral compression fractures were divided into two groups. The observation group（n=36） underwent minimally invasive spinal operation, and the control group（n=36） received conventional conservative treatment. Compared the patients＇ postoperative life situation, curative effect and observation of postoperative complications between the two groups. Results： The two groups of patients before treatment for compressed centrum height/height of vertebral body vertebra and posterior half, there were no obvious convex Cobb angle and spinal bone invasion rate differences（P0.05）. After treatment, the above index were significantly improved, and compared with the control group, the observation group improved more significantly（P0.05）. The excellent and good rate in the observation group, but 58.3% in the control group,including 6 cases of patients with exacerbation of symptoms to operation treatment. The treatment group showed better effect than the control group（P0.05）. The observation group had no implant loosening, fracture, pseudarthrosis, paraplegia and other complications,with strong and reliable screw internal fixation system. The two groups were followed up for a mean follow-up time of（9.7 ±2.5）months, the observation group the average time（4.1 ±1.7） d, muscle recovery time of（3.7 ±0.8） weeks, Frankel neural function recovered to E grade; the control group took the average time（7.4 ±3） d, muscle recovery time took（5.9 ±1.4） weeks, Frankel neural function score： 6 cases of grade D, 30 cases of grade E. Conclusions： Minimally invasive spinal operation can effectively improve the osteoporotic vertebral fracture mechanics in patients with skeletal changes, can effectively guarantee the recovery, and the postoperative curative effect is better. It does not cause serious complications, and is worthy of clinical application.