伤椎置钉治疗骨质疏松性椎体爆裂骨折的随访研究

Follow-up study on pedicle fixation for treatment of thoracolumbar burst fractures in patients with osteoporosis

目的探讨伤椎置钉联合术后疗法治疗骨质疏松性椎体爆裂骨折的手术效果及功能恢复情况,为该类疾病的治疗方案提供理论依据。方法回顾性分析本院2012年6月至2015年10月121例骨质疏松性椎体爆裂骨折患者手术治疗的临床资料。根据手术方式的不同将行短节段固定的患者作为对照组(n=56),单节段伤椎置钉作为观察组(n=65),术后给予1年的抗骨质疏松治疗。评估比较术前、术后3 d,术后1、3、12个月的疼痛视觉模拟评分(VAS),Oswestry功能障碍指数评分(ODI),伤椎前缘高度,伤椎后凸Cobb角及骨密度值。结果术后各组的VAS评分、ODI评分、伤椎前缘高度、伤椎后凸Cobb角均显著改善,差异具有统计学意义(P<0.05)。术后3 d,观察组的VAS评分显著好于对照组,差异具有统计学意义(P<0.05);而术后3、6、12个月,2组间差异均无统计学意义(P>0.05)。观察组的ODI评分在术后3 d及3个月均好于对照组,差异具有统计学意义(P<0.05),其后至随访结束均未表现出差异。而伤椎置钉的使用在术后3 d至12个月均显著改善了伤椎的前缘高度和后凸Cobb角,差异具有统计学意义(P<0.05)。12个月的抗骨质疏松治疗均显著提高了骨密度(P<0.05)。结论伤椎置钉有利于骨质疏松合并胸腰椎爆裂性骨折患者术后的疼痛减轻,促进功能和正常解剖结构的恢复。抗骨质疏松治疗有利于提高患者的骨密度。

Objective To explore the effect of pedicle fixation for treatment of thoracolumbar burst fractures in patients with osteoporo- sis, and to provide more evidence for the treatment. Methods Retrospectively analyzed the clinical data of 121 patients with osteoporotic ver- tebral burst fracture from June 2012 to October 2015. And these patients were divided into two groups according to different operation meth- ods, namely the control group （ n = 56） who were given short segment fixation and the observation group （ n = 65 ） who were given single seg- ment fixation. The visual analogue scale（VAS） , Oswestry disability index（ODI） , vertebral height, kyphotic angle and bone mineral density of the two groups were analyzed before surgery and 3 days, 1 month,3 months and 12 months after surgery. Results The VAS score, ODI score, vertebral height, and Cobb angle of the injured vertebra were significantly improved in both of the two groups, and the difference was statisti- cally significant （ P 〈 0.05 ）. The VAS score of the observation group was better than that of the control group 3 days after surgery with statis- tically significant difference （ P 〈 0.05 ）. But there was no significant difference 3 months ,6 months and 12 months after surgery（ P 〉 0.05 ）. The ODI score of the observation group was better than that of the control group 3 days and 3 months after surgery with statistically significant difference （ P 〈 0.05 ）, and there was no significant difference between the two groups till the end of follow-up. Pedicle fixation at the injured vertebra significantly improved the vertebral height and Cobb angle with statistically significant difference （ P 〈 0.05 ）. And the anti-osteopo- rosis treatment significantly increased the bone mineral density （ P 〈 0.05 ）. Conclusion Pedicle fixation at the injured vertebra is useful in pain relief as well as function and anatomical structure restoring. And anti-osteoporosis treatment is necessary for the bone mineral density increase.