后路经椎弓根内固定联合椎体成形术治疗老年胸腰段脊柱骨折的临床价值

Clinical value of posterior transpedicular fixation combined with vertebroplasty in the treatment of thoracolumbar spine fractures in elderly patients

目的 探讨后路经椎弓根内固定联合椎体成形术治疗老年胸腰段脊柱骨折的临床效果.方法 48例胸腰段脊柱骨折患者纳入观察研究对象,所有患者均采用后路经椎弓根内固定联合椎体成形术进行治疗.比较患者治疗前后脊柱后突Cobb＇s角、椎体压缩率,椎管狭窄率,Frankel分级,视觉模拟评分（VAS）的差异.结果 平均手术时间（125.9±58.3） min,术中平均透视时间（14.0±3.8） min,术中平均出血量（408.7±62.3） ml.平均随访（19.1±3.6）个月,48例患者未出现内固定松动、断裂,伤口感染、红肿及不愈合情况,2例骨水泥椎管渗漏,未出现神经系统症状.治疗后患者Cobb＇s角发生显著改变（F=168.51,P〈0.05）,术后1个月（2.8±0.8）°和术后6个月（4.3±1.1）°均显著低于术前（24.1±6.8）°,P〈0.05;椎体压缩率发生显著改变（F=95.16,P〈0.05）,术后1个月（10.1±3.7）%和术后6个月（14.5±3.9）%的椎体压缩率均显著低于术前（40.2±8.8）%,F值分别为74.62、62.68,P〈0.05.椎管狭窄率发生显著改变（F=254.85,P〈0.05）,术后1个月（7.2±2.4）%和术后6个月（10.3±3.6）%的椎管狭窄率均显著低于术前（43.2±5.4）%,F值分别为48.83、36.26,P〈0.05.VAS评分发生显著改变（F=56.84,P〈0.05）,术后1个月（3.5±1.7）分和术后6个月（2.6±1.5）分均显著低于术前（6.8±2.8）分,F值分别为10.88、9.59,P〈0.05.配对秩和检验结果显示,患者术后Frankel分级显著改善（Z=5.64,P〈0.05）.结论 后路经椎弓根内固定结合椎体成形术治疗老年胸腰段脊椎柱骨折效果较好.

Objective To investigate the clinical value of posterior transpedicular fixation combined with vertebroplasty in the treatment of thoracolumbar spine fractures in elderly patients.Methods Forty-eight patients with thoracolumbar spine fractures were included in the study.All the patients received posterior transpedicular fixation combined with vertebroplasty.Posterior spinal Cobb＇s angles,vertebral compression rates,spinal stenosis,Frankel classification and VAS scores before and after operation were compared.Results The mean operative time was （125.9±58.3） min,the average intraoperative fluoroscopy time was （14.0±3.8） min,and the average intraoperative blood loss was （408.7±62.3） ml.There was no internal fixation loosening,fracture,wound infection,swelling and nonunion in 48 cases on average follow-up （19.1±3.6） months.2 cased experienced bone cement leakage but no neurological symptoms.After the treatment,Cobb＇s angles changed significantly （F=168.51,P〈0.05）.Cobb＇s angles at 1 months and 6 months after operation were significantly lower than that before the operation （（2.8±0.8）°vs.（4.3±1.1）°;vs.（24.1±6.8）°,P〈0.05）.Vertebral compression rates changed significantly （F=95.16,P〈0.05）.Vertebral compression rates at 1 months and 6 months after operation were significantly lower than the preoperative vertebral compression rate （（10.1±3.7）% vs.（14.5±3.9）% vs.（40.2±8.8）%,F=74.62,62.68,P〈0.05）.The spinal stenosis rates changed significantly （F=254.85,P〈0.05）,the spinal stenosis rates at 1 months and 6 months after operation were significantly lower than the preoperative one （（7.2±2.4）% vs.（10.3±3.6）% vs.（43.2±5.4）%,F=48.83,36.26,P〈0.05）.VAS scores changed significantly （F=56.84,P〈0.05）.VAS scores at 1 months and 6 months after operation were significantly lower than preoperative VAS score （（3.5±1.7） vs.（2.6±1.5） vs.（6.8±2.8）,F=10.88,9.59,P〈0.05）.As paired rank test showed,the Frankel classification were significantly improved after operation （Z=5.64,P〈0.05）.Conclusion Posterior transpedicular fixation combined with vertebroplasty has a significant curative effect on the treatment of thoracolumbar spine fractures in elderly patients.