骨水泥灌注空心椎弓根螺钉内固定治疗不稳定性胸腰椎骨折合并骨质疏松临床疗效研究

Polymethylmethacrylate augmented pedicle screw instrumentation fixation combined for osteoporotic thoracolumbar unstable fractures

目的:探讨骨水泥灌注空心椎弓根螺钉内固定治疗不稳定性胸腰椎爆裂骨折且合并骨质疏松患者的临床疗效。方法:对不稳定性胸腰椎骨折并骨质疏松患者,分别采用骨水泥灌注空心椎弓根螺钉内固定治疗(52例)和传统椎弓根钉内固定治疗(60例),对比分析两组术后3 d、术后3月和末次随访时的伤椎前后缘压缩率、后凸Cobb角、伤椎楔变角及腰背疼痛评分,比较两种内固定方法对腰背疼痛改善情况及预防远期椎体塌陷的差异。结果:采用骨水泥灌注空心椎弓根螺钉内固定治疗的患者,术后3 d、术后3月和术后12月时椎体前后缘压缩率、后凸Cobb角、伤椎楔变角与采用传统椎弓根钉内固定治疗组比较其差异有统计学意义(P<0.05);疼痛评分术后3 d差异有统计学意义,术后3月和12月时差异无统计学意义(P>0.05)。结论:骨水泥灌注空心椎弓根螺钉内固定治疗不稳定性胸腰椎骨折合并骨质疏松患者,效果优于传统椎弓根钉内固定。该固定方法在有效预防骨折术后远期椎体高度丢失、维持病椎的高度和强度等方面有明显优势。患者可较早下地,减少胸腰椎骨折后各种并发症。

Objective:To compare the efficacy of using PMMA augmented pedicle screw instrumentation and usual pedicle screw instrumentation for treatment of osteoporotic unstable thoracolumbar fractures.Methods:52 cases with osteoporotic thoracolumbar fracturesr undergoing polymethylmethacrylate augmented pedicle screw instrumentation,63 cases with usual pedicle screw instrumentation were included in this study. Then measure the front and back edges height of the injured vertebra, kyphosis Cobb ’s angle, Wedge angle of injured vertebra,visual analogue scale(VAS),and comparing the difference between two instrumentation in improvement of low back pain and prevention of long-term vertebral collapse.Results:All patients were followed up for 12~24 months and no peripheral complications were noted in augmented pedicle screw group. In PMMA augmented pedicle screw group, All observation indicators were significantly statistical differences(P<0.05) from usual pedicle screw instrumentation group except VAS.Conclusion:PMMA Bone cement augmentation of pedicle screw fixation for osteoporotic thoracolumbar unstable fractures, can effectively restore spinal stability,maintain the height and strength for injured vertebral significantly, avoid vertebral collapse and reduce complications.