经皮注射可吸收型磷酸钙在胸腰段骨折治疗中的应用

Application of absorbable calcium phosphate cement in the treatment of thoracolumbar fractures

目的分析比较经皮注射可吸收型磷酸钙结合椎弓根钉内固定与传统开放式手术治疗胸腰段骨折的临床疗效。方法回顾性分析2017年1月—2018年11月河北省承德市中心医院骨科收治的胸腰段骨折患者60例,男性28例,女性32例;年龄24~64岁,平均48.0岁。按照手术方法不同分为微创磷酸钙注射组(28例)和传统开放组(32例),微创磷酸钙注射组行经皮椎弓根钉内固定结合注射可吸收型磷酸钙手术治疗,传统开放组行传统开放后路骨折撑开复位椎弓根钉内固定手术。比较两组患者术前、术后末次随访时的VAS评分、腰椎ODI指数、伤椎前缘压缩比、Cobb角及围手术期各项指标。结果60例患者均获得随访,时间12~18个月,平均14.6个月。微创磷酸钙注射组手术时间、出血量、平均住院日及切口总长度方面均优于传统开放组[(79.4±12.3)min vs.(100.7±13.6)min、(65.3±14.1)mL vs.(150.4±35.2)mL、(8.2±1.4)d vs.(10.8±2.3)d、(7.6±1.2)cm vs.(11.5±2.7)cm,P<0.05]。两组患者术后伤椎前缘压缩比、Cobb角、ODI指数及VAS评分均优于术前,差异有统计学意义(P<0.05)。术后12~18个月末次随访时微创磷酸钙注射组伤椎前缘压缩比、Cobb角、ODI指数及VAS评分均优于传统开放组[(91.6±2.6)%vs.(86.8±2.7)%、(9.8±2.3)°vs.(13.6±2.4)°、(13.6±4.3)%vs.(16.9±3.8)%、(1.8±0.6)分vs.(2.9±0.8)分,P<0.05]。结论经皮椎弓根钉内固定结合可吸收型磷酸钙伤椎强化治疗胸腰段骨折,可以改善患者胸腰椎功能,防止术后椎体高度丢失,创伤小、恢复快,是一种安全有效的手术方式。

Objective To compare the clinical findings of percutaneous pedicle screw fixation combined with calcium phosphate and traditional open surgery for thoracolumbar fracture,in order to evaluate the clinical efficacy.Methods Totally 60 patients with thoracolumbar fracture admitted to Chengde Central Hospital,Hebei Province from Jan.2017 to Nov.2018 were retrospectively analyzed,including 28 males and 32 females.The age ranged from 24 to 64,with an average age of 48.0 years.According to different surgical methods,the patients were divided into the minimally invasive calcium phosphate injection group(28 cases)and the traditional open group(32 cases).The minimally invasive calcium phosphate injection group received percutaneous pedicle screw internal fixation combined with absorbable calcium phosphate,while the traditional open group received traditional open posterior fracture distraction and reduction pedicle screw internal fixation.VAS score,lumbar ODI index,compression ratio of anterior edge of injured vertebra,Cobb's Angle and various indicators during perioperative period were compared and analyzed in the two groups of patients before and after the last follow-up.Results All the 60 patients were followed up for 12-18 months(mean 14.6 months).The minimally invasive calcium phosphate injection group was superior to the traditional open group in operation time,blood loss,average length of hospital stay and total incision length[(79.4±12.3)min vs.(100.7±13.6)min,(65.3±14.1)mL vs.(150.4±35.2)mL,(8.2±1.4)d vs.(10.8±2.3)d,(7.6±1.2)cm vs.(11.5±2.7)cm,P<0.05].The compression ratio,Cobb's angle,ODI index and VAS score of the anterior edge of injured vertebra of the two groups were all better than those before operation,and the differences were statistically significant(P<0.05).The compression ratio,Cobb's angle,ODI index and VAS score in the minimally invasive calcium phosphate injection group were all better than those in the traditional open group[(91.6±2.6)%vs.(86.8±2.7)%,(9.8±2.3)°vs.(13.6±2.4)°,(13.6±4.3)%vs.(16.9±3.8)%,(1.8±0.6)points vs.(2.9±0.8)points,P<0.05].Conclusion Percutaneous pedicle screw internal fixation combined with absorbable calcium-phosphate to enhance the treatment of thoracolumbar fracture,can improve the patient's function,prevent postoperative vertebral height loss with small trauma and rapid recovery.It is a safe and effective surgical method.