改良Wiltse入路椎弓根钉内固定联合经椎弓根植骨对老年骨质疏松性椎体压缩骨折的疗效观察

Effect of modified Wiltse approach pedicle screw internal fixation combined with transpedicular bone grafting on the vertebral body and complications of senile osteoporotic vertebral compression fractures

目的探讨改良Wiltse入路椎弓根钉内固定联合经椎弓根植骨对老年骨质疏松性椎体压缩骨折的临床疗效。方法选取杭州市富阳中医骨伤医院2018年10月至2019年10月收治的94例老年骨质疏松性椎体压缩骨折患者为研究对象,按随机摸球法将患者分成对照组和观察组,各47例,对照组行后路短节段复位内固定术结合经椎弓根植骨治疗,观察组行改良Wiltse入路椎弓根内固定协同经椎弓根植骨治疗。观察对比两组手术相关指标、伤椎状况、椎体恢复情况、住院时间与骨折愈合时间、并发症发生率情况。结果手术相关指标比较,观察组术中出血量、术后3 d视觉模拟评分法(visual analogue scale,VAS)评分及手术时间显著低于对照组(P<0.05)。伤椎状况比较,术前两组伤椎Cobb角、椎体矢状面指数、椎体高度丢失率比较,差异均无统计学意义(P>0.05);两组术后3d伤椎Cobb角、椎体高度丢失率均低于术前,术后1年椎体矢状面指数高于术前(P<0.05);观察组术后3 d伤椎Cobb角、椎体高度丢失率显著低于对照组,术后1年椎体矢状面指数显著高于对照组(P<0.05)。伤椎恢复情况比较,两组术前功能障碍指数问卷表(oswestry disability index,ODI)评分比较,差异无统计学意义(P>0.05),观察组Cobb角改善率、椎体高度恢复率、术后3个月ODI评分均显著高于对照组(P<0.05)。观察组住院时间、骨折愈合时间显著低于对照组(P<0.05),观察组总并发症发生率(4.26%)显著低于对照组(19.15%)(P<0.05)。结论在老年骨质疏松性椎体压缩骨折治疗中改良Wiltse入路椎弓根钉内固定与经椎弓根植骨的联合运用,可减少患者术中出血量,缩短手术时间、住院时间及骨折愈合时间,改善伤椎Cobb角,促进伤椎高度与功能的恢复,降低并发症发生率。

Objective To investigate the effects of internal fixation with pedicle screw via modified Wiltse approach combined with transpedicular bone grafting on the vertebral body and complications of senile osteoporotic vertebral compression fractures(OVCF).Methods Ninety-four elderly patients with osteoporotic vertebral compression fractures who were admitted to Hangzhou Fuyang Traditional Chinese Medicine Orthopedics Hospital from Oct.2018 to Oct.2019 were selected as the research objects.The patients were divided into control group and observation group according to the random ball touch method.For 47 cases,the control group underwent posterior short-segment reduction and internal fixation combined with transpedicular bone grafting,and the observation group underwent modified Wiltse approach pedicle internal fixation combined with transpedicular bone grafting.The two groups were observed and compared in terms of surgery related indicators,the condition of the injured vertebrae,the recovery of the vertebral body,the length of hospitalization and fracture healing time,and the incidence of complications.Results In comparison of the operation-related indexes between the two groups,the intraoperative blood loss,3d postoperative visual analogue scale(VAS)score and operation time of the observation group were significantly lower,than those of the control group(P<0.05).In comparison of the condition of the injured vertebrae between the two groups,there was no significant difference in the ratio of the loss rate of the injured vertebrae Cobb angle,vertebral body sagittal plane index,and vertebral body height between the two groups before operation(P>0.05).The loss rates of Cobb angle and vertebral body height of the injured vertebrae in the two groups were lower than that before operation at 3 days after operation,and the sagittal index of the vertebral body was higher than before operation at 1 year after operation(P<0.05).The loss rate of Cobb angle and vertebral body height of the injured vertebral body in the observation group was significantly lower than that of the control group at 3 days postoperatively,and the vertebral body sagittal plane index was significantly higher than that of the control group at 1 year postoperatively(P<0.05).Comparing the recovery of injured vertebrae between the two groups,there was no statistically significant difference between the preoperative oswestry disability index(ODI)scores of the two groups(P>0.05),the improvement rate of Cobb angle and the recovery rate of vertebral body height in the observation group,ODI scores at 3 months after operation were significantly higher than those of the control group(P<0.05).The hospitalization time and fracture healing time of the observation group were significantly lower than those of the control group(P<0.05).The total incidence of complications in the observation group(4.26%)was significantly lower than the total incidence of complications in the control group(19.15%)(P<0.05).Conclusion The combined use of internal fixation with pedicle screw via modified Wiltse approach combined with transpedicular bone grafting in treatment of elderly OVCF can reduce the amount of intraoperative blood loss,shorten the operation time and hospital stay and fracture healing time,improve the Cobb angle of the injured vertebra,promote the recovery of the height and function of the injured vertebra,and reduce the incidence of complications.