经皮椎弓根钉内固定结合磷酸钙骨水泥伤椎强化治疗胸腰段骨折

Percutaneous pedicle screw fixation combined with calcium phosphate cement for the treatment of thoracolumbar fractures

目的分析经皮椎弓根钉内固定结合磷酸钙伤椎强化治疗胸腰段骨折的临床及影像学结果,评价其临床疗效.方法回顾性分析2017年1月至2018年1月河北省承德市中心医院收治的49例胸腰段骨折患者,23例采用经皮椎弓根钉内固定并结合磷酸钙骨水泥伤椎内注射强化手术治疗(磷酸钙骨水泥注射强化组),26例采用单纯经皮椎弓根钉复位内固定术(单纯内固定组).对患者的术前、术后1 w及末次随访时的VAS疼痛评分、腰椎ODI评分,伤椎前缘压缩比及Cobb角进行对比分析.结果49例患者均获得满意随访,随访时间12~16个月,平均随访时间为(13.5±2.2)个月,随访率100%.两组患者的出血量及平均住院日之间的差异无统计学意义,磷酸钙骨水泥注射强化组手术时间长于单纯内固定组,差异有统计学意义(t=3.681,P=0.001).重复测量资料的方差分析显示:在伤椎前缘压缩比、Cobb角、ODI评分及VAS评分方面,组别间差异有统计学意义(F=5.139,F=17.830,F=3.351,F=3.840,P<0.05),不同时间点差异有统计学意义(F=362.923,F=352.555,F=956.735,F=347.468,P<0.05).随时间延长两组伤椎前缘压缩比均较术前增加,末次随访时较术后下降,且磷酸钙骨水泥注射强化组末次随访时伤椎前缘压缩比优于单纯内固定组(P<0.05).两组Cobb角均较术前减小,末次随访较术后增加,磷酸钙骨水泥注射强化组术后和末次随访Cobb角均优于单纯内固定组(P<0.05).两组ODI评分逐步降低,且磷酸钙骨水泥注射强化组末次随访ODI评分低于单纯内固定组(P<0.05).两组VAS评分逐渐降低,且磷酸钙骨水泥注射强化组末次随访VAS评分低于单纯内固定组(P<0.05).结论经皮椎弓根钉内固定结合磷酸钙骨水泥伤椎强化治疗胸腰段骨折,可有效的恢复椎体高度,增强早期椎体内支撑强度,改善患者功能,防止术后椎体高度丢失,是一种安全有效的手术方式.

Objective To evaluate the clinical effect of percutaneous pedicle screw fixation combined with calcium phosphate bone cement injection in the treatment of thoracolumbar fractures by analysis the clinical and imaging results.Methods Forty-nine patients were enrolled this study.Patients were divided into group A(23 cases)and group B(26 cases).Patients in group A were treated with percutaneous pedicle screw fixation combined with calcium phosphate bone cement injection in the thoracolumbar fractures,while patients in group B were treated with percutaneous pedicle screw fixation.VAS pain scores,ODI scores,anterior compression ratio of injured vertebrae and Cobb angle were monitored before surgical treatment and after surgical treatment at 1 week and last follow-up.Results All the 49 patients were followed up satisfactorily for 12 to 16 months,with an average follow-up time of(13.5±2.2)months and a follow-up rate of 100%.The amount of bleeding and the average length of stay had no statistical between the two groups.The operation time of group A was longer than that in group B(t=3.681,P=0.001).RMANOVA analysis showed no significant difference about anterior compression ratio of injured vertebrae,Cobb angle,ODI and VAS scores between two groups,(F=5.139,F=17.830,F=3.351,F=3.840,P<0.05),and the differences at different time points were statistically significant(F=362.923,F=352.555,F=956.735,F=347.468,P<0.05).With the extension of time,the anterior compression ratio of the injured vertebra in the two groups increased compared with that before surgery,and the last follow-up group decreased compared with that after surgery,and the anterior compression ratio of the injured vertebra in the last follow-up group was better than that in the control group(P<0.05).The Cobb Angle in both groups was smaller than that before the operation and increased in the last follow-up than that after the operation.The Cobb Angle in group A was better than that in group B after the operation and at the last follow-up(P<0.05).ODI score of the two groups gradually decreased,and ODI score of group A at the last follow-up was lower than that of group B(P<0.05).VAS score of the two groups gradually decreased,and VAS score of group A at the last follow-up was lower than that of group B(P<0.05).Conclusion The operation of percutaneous pedicle screw fixation combined with calcium phosphate bone cement injection in the treatment of thoracolumbar fractures can effectively restore vertebral height,enhance early vertebral support strength,improve patients function and prevent vertebral height loss post-operation,which is a safe and effective surgical procedure.