椎间骨桥对骨质疏松性椎体压缩骨折愈合的影响

Effects of intervertebral bridging ossifications in patients of osteoporotic vertebral compression fracture on bone fracture healing

目的分析椎间骨桥对骨质疏松性椎体压缩骨折(OVCF)愈合的影响。方法选取2010年3月至2015年6月我科收治的部分胸腰椎椎体上终板骨折的患者170例,将其中行保守治疗3个月后仍表现为椎体上终板骨皮质不连的患者60例作为观察组,保守治疗3个月后伤椎愈合良好患者110例作为对照组,对比分析2组患者在伤后3周内伤椎周围骨桥的分布情况。结果观察组分布在T_9~T_(10)、T_(10)~T_(11)及T_(11)~T_(12)节段的椎间骨桥数量及伤椎上方第2个椎间隙骨桥的数量明显高于对照组,与对照组相比,观察组存在较大的伤椎楔形角。结论新发的骨质疏松性椎体压缩骨折上方第2个椎间隙存在完整骨桥时或者矢状位伤椎楔形角度大于14.2°时,采取保守治疗可能增加伤椎不愈合的风险,采取保守治疗还是外科手术干预,应慎重选择。

Objective To investigate the effects of intervertebral bridging ossifications in patients of osteoporotic vertebral compression fracture （OVCF） on bone fracture healing. Methods A total of 170 patients of thoracolumbar vertebral endplate fracture who were admitted into our hospital were selected. Divided these patients into the observation group, namely 60 patients with nonunion of vertebral endplate after 3 months of conservative treatment, and the control group, including 110 patients with well healed vertebra after 3 months of conservative treatment. Compared the distribution of intervertebral bridging ossifications of the two groups 3 weeks after injury. Results The incidence of bridging ossification at levels of T9 to T10 ,T10to T11 ,T11 to T12 in the observation group were significantly higher than that in the control group. And it showed a significantly higher incidence of bridging ossification at the second proximal intervertebral segment in the observation group than that of the control group. There was a significantly greater sagittal wedge angle in the observation group compared with the control group. Conclusion Conservative treatment may increase the risk of nonunion of osteoporotic vertebral compression fractures when there is a bridg- ing ossification at the second proximal intervertebral level or the sagittal wedge angle was greater than 14.2° in a fresh osteoporotic vertebral compression fracture. It should be a careful choose whether to take conservative treatment or surgical intervention.