不同椎弓根螺钉直径在椎体压缩性骨折后维持内固定稳定性的效果对比

Comparison of effects of different pedicle screw diameters on maintaining stability of internal fixation after vertebral compression fracture

目的分析不同椎弓根螺钉直径对椎体压缩性骨折后内固定稳定性的影响。方法回顾性分析2017年4月-2018年1月河北北方学院附属第一医院骨外科收治的97例腰椎椎体骨质疏松性压缩性骨折患者的临床资料。所有患者符合椎弓根螺钉内固定联合椎体成形手术指征,术前CT测量椎弓根直径及长度,其中A组包括34例患者,术中置入椎弓根螺钉直径接近(椎弓根直径-1.0 mm);B组包括31例患者,术中置入椎弓根螺钉直径接近(椎弓根直径-0.5 mm);C组包括32例患者,术中置入椎弓根螺钉直径接近椎弓根直径。记录3组患者手术时长、术中失血量和术后住院时间等手术情况,术后随访患者视觉模拟评分(VAS)、Oswestry功能障碍指数评分(ODL)以评价治疗效果,根据影像学资料判断患者的断钉率、螺钉松动率、假关节形成率情况以反映其内固定稳定性,并将结果进行统计学比较。结果3组患者手术时长、术中失血量、术后住院时间无明显差异(P>0.05);视觉模拟评分(VAS)、Oswestry功能障碍指数评分(ODL)相较于术前均有所改善,并且C组明显优于A组和B组(P<0.05);不良反应发生情况,螺钉松动率A组最高,断钉率、假关节形成率C组最高(P<0.05)。结论针对骨质疏松性椎体压缩性骨折患者,置入的椎弓根螺钉的直径不宜过小,对关节功能恢复效果不理想,并且会出现螺钉松动的情况;但置入的椎弓根螺钉直径也不宜过大,会造成骨组织创伤过大,降低术后内固定的稳定性,使断钉率和假关节形成率明显提高。因此在实际运用中,应适当增加伤锥所置螺钉直径,根据术前CT结果,选择接近低于椎弓根直径0.5 mm的螺钉为宜,在保证内固定的稳定性的同时提高手术效果。

Objective To analyze the effects of different pedicle screw diameters on the stability of internal fixation after vertebral compression fracture.MethodsThe clinical data of 97 patients with osteoporotic compression fracture of lumbar vertebrae treated in our hospital from April 2017 to January 2018 were analyzed retrospectively.All patients were in accordance with the indication of pedicle screw internal fixation combined with vertebroplasty.The diameter and length of pedicle were measured by CT before operation.Group A included 34 patients,and the diameter of pedicle screw was close to that of pedicle screw(pedicle diameter-1.0 mm).Group B included 31 patients,and the diameter of pedicle screw was close to that of pedicle screw in group B.the diameter of pedicle screw was close to that of pedicle screw in group B(n=32).The diameter of pedicle screw was close to that of pedicle screw in group B(n=31).The diameter of pedicle screw was close to that of pedicle screw in group B.The operation duration,intraoperative blood loss and postoperative hospital stay were recorded in the three groups.The visual analog score(VAS)and Oswestry dysfunction index(ODL)were followed up to evaluate the therapeutic effect.According to the imaging data,the nail breaking rate,screw loosening rate and pseudarthrosis rate were judged to reflect the stability of internal fixation.ResultsThere were no significant differences in operation time,intraoperative blood loss and postoperative hospital stay among the three groups(P>0.05).The visual simulation score(VAS)and Oswestry dysfunction index(ODL)were improved compared with those before the operation,and the score of group C was significantly better than that of group A and group B(P<005).The incidence of adverse reactions and screw loosening rate were the highest in group A(P<0.05).The rate of nail breakage and pseudarthrosis were the highest in group C(P<0.05).ConclusionFor patients with osteoporotic vertebral compression fracture,the diameter of pedicle screw should not be too small,the effect of joint function recovery is not ideal,and screw loosening will occur.However,the diameter of the inserted pedicle screw should not be too large,which will cause excessive trauma of bone tissue,and reduce the stability of postoperative internal fixation,so that the rate of broken nails and pseudarthrosis significantly increased.Therefore,in practical application,the screw diameter of the injury cone should be increased properly.According to the results of preoperative CT,it is appropriate to select the screw which is close to the pedicle diameter 0.5mm,so as to ensure the stability of internal fixation and improve the effect of operation.