伤椎植骨结合椎弓根钉棒系统辅助药物治疗老年腰椎压缩性骨折

Efficacy of bone grafting in the injured vertebrae combined with pedicle screw-rod system assisted with drugs in treating lumbar vertebral compression fracture in the elderly

目的探讨伤椎植骨与不植骨结合椎弓根钉棒系统辅助药物治疗老年腰椎压缩性骨折的临床疗效。方法采用回顾性病例对照研究分析2015年10月—2018年10月华中科技大学同济医学院附属协和医院收治的48例老年腰椎压缩性骨折患者临床资料,其中男34例,女14例;年龄60~78岁[(62.8±2.5)岁]。损伤节段:L137例,L27例,L32例,L42例。植骨组20例,其中男15例,女5例;年龄60~78岁[(63.7±2.1)岁]。非植骨组28例,其中男19例,女9例;年龄60~75岁[(62.4±2.9)岁]。植骨组术前Frankel分级D级15例,E级5例;非植骨组术前Frankel分级D级18例,E级10例。两组患者均行椎弓根钉棒系统固定+辅助抗骨质疏松药物治疗,其中植骨组行伤椎植骨,非植骨组伤椎不植骨。比较两组术中出血量、单节段钉棒置入时间、术前及术后1年随访时的视觉模拟评分(VAS)、术后3个月及术后1年骨折愈合情况;分别测量并比较术前、术后1 d及术后1年椎体高度压缩率及术后1年椎体高度丢失率。评估术前、术后的脊髓损伤Frankel分级等级。比较伤口愈合情况、下肢静脉血栓形成、肺部感染及压疮等情况。结果48例患者均获随访,其中植骨组随访时间12~25个月[(16.2±3.4)个月],非植骨组15~24个月[(17.5±5.4)个月](P>0.05)。植骨组和非植骨组术中出血量分别为(240±70)ml和(210±65)ml(P>0.05)。植骨组单节段钉棒置入时间为(38.5±9.6)min,较非植骨组(30.5±5.4)min延长(P<0.05)。植骨组术前和术后1年的VAS分别为(7.5±1.8)分和(1.5±0.7)分,非植骨组分别为(7.8±1.4)分和(2.9±1.2)分,两组术后1年的VAS比较差异有统计学意义(P<0.05)。植骨组术后3个月和1年的骨折愈合率分别为85%(17/20)和95%(19/20),非植骨组分别为64%(18/28)和86%(24/28)(P>0.05)。两组患者术前及术后椎体高度压缩率差异无统计学意义(P>0.05)。植骨组术后1年的伤椎椎体高度丢失率为3%(2%,4%),非植骨组为6%(5%,8%)(P<0.05)。两组患者术后Frankel分级均为E级。随访期间,患者均未并发下肢深静脉血栓、压疮或肺部感染等,其中植骨组术后1年骨折不愈合1例,非植骨组4例(P>0.05)。结论伤椎植骨结合椎弓根钉棒系统辅助药物治疗老年腰椎压缩性骨折,与伤椎不植骨治疗相比,虽增加了置钉时间,但可有效恢复并维持伤椎的椎体高度,减轻术后疼痛,并可能提高骨折愈合率,疗效更好。

Objective To explore the clinical effect of bone grafting in the injured vertebrae combined with pedicle screw-rod system assisted with drugs in treating lumbar vertebral compression fracture in the elderly.Methods A retrospective case-control study was carried out to analyze the clinical data of 48 cases of lumbar vertebral compression fracture in the elderly admitted to the Union Hospital between October 2015 and October 2018.There were 34 males and 14 females,aged 60-78 years[(62.8±2.5)years].Segment of injury was L1 in 37 cases,L2 in 7,L3 in 2,and L4 in 4.There were 20 cases in bone grafting group involving 15 males and five females,aged from 60 to 78 years[(63.7±2.1)years].There were 28 cases in non-bone grafting group involving 19 males and nine females,aged from 60 to 75 years[(62.4±2.9)years].The Frankel scale in bone grafting group was grade D in 15 cases and grade E in 5,and in non-bone grafting group was grade D in 18 cases and grade E in 10.All the cases were treated by pedicle screw fixation combined with antiosteoporosis drugs,and the bone grafting group were treated by bone grafting via the injured vertebrae,but the other group were not.The intraoperative blood loss and operation time for each segmental vertebrae were recorded.The visual analogue scale(VAS)before operation and one year after operation,the bone healing at three months and one year postoperatively were recorded.The compression rate of the injured vertebrae at operation,at one day and one-year postoperatively as well as the height loss of the injured vertebrae at postoperative one year were measured.Spinal cord injury was also evaluated by Frankel scale.Wound healing,lower limb thrombosis,lung infection and ulcer were observed.Results All the cases were followed up,with duration for 12-25 months[(16.2±3.4)months]in bone grafting group and 15-24 months[(17.5±5.4)months]in non-bone grafting group(P>0.05).The blood loss was(240±70)ml in bone grafting group and(210±65)ml in non-bone grafting group(P>0.05).Screw implantation time for each segment was(38.5±9.6)minutes in bone grafting group and(30.5±5.4)minutes in non-bone grafting group(P<0.05).The VAS was(7.5±1.8)points preoperatively and(1.5±0.7)points at one year postoperatively in bone grafting group,while(7.8±1.4)points and(2.9±1.2)points in non-bone grafting group,with significant difference between the two groups at one year postoperatively(P<0.05).The fracture healing rate was 85%(17/20)and 95%(19/20)at three months and one year postoperatively in bone grafting group,while 64%(18/28)and 86%(24/28)in non-bone grafting group,with no statistical difference between the two groups(P>0.05).No significant difference was found in compression rate of the injured vertebral height between the two groups before and after operation(P>0.05).The height loss rate of the injured vertebrae was 3%(2%,4%)at one year postoperatively in bone grafting group and 6%(5%,8%)in non-bone grafting group(P<0.05).The Frankel scale was all Grade E postoperatively.During the follow-up,no lower limb thrombosis,lung infection or ulcer occurred.One case had bone non-union in bone grafting group and four in non-bone grafting group(P>0.05).Conclusion For lumbar vertebral compression fracture in the elderly,bone grafting in the injured vertebrae combined with pedicle screw-rod system assisted with drugs is significantly better in recovering and maintaining the injured vertebrae height,relieving the pain and promoting the bone healing,although the screw implantation time is prolonged.