一种新型可灌注骨水泥强化椎弓根螺钉固定治疗骨质疏松性胸腰椎骨折的疗效观察

Comparative study on the effect of bone cement reinforced hollow side hole screw fixation and pedicle screw fixation strengthened by screw cement in the treatment of osteoporotic thoracolumbar fracture

目的对比可灌注骨水泥强化椎弓根螺钉与与钉道灌注骨水泥强化椎弓根螺钉固定治疗骨质疏松性胸腰椎骨折的疗效。方法前瞻性选取2016年5月~2018年5月我院收治的86例骨质疏松性胸腰椎骨折患者,根据入组奇偶顺序分为两组各43例。钉尾组给予可灌注骨水泥强化椎弓根螺钉固定治疗,钉道组给予钉道骨水泥强化椎弓根螺钉固定治疗,所有患者术后随访12个月。结果两组手术时间、术中出血量、术后首次下床活动时间、术后住院时间、骨折愈合时间比较,均无统计学差异(P>0.05)。钉尾组术后第6、12个月的椎体前缘丢失高度、伤椎前缘压缩率、伤椎后缘压缩率、Cobb角、受压面积均低于钉道组(P<0.05)。钉尾组术后第1、6、12个月的疼痛VAS评分、ODI指数均显著低于钉道组(P<0.05),SF-36评分均显著高于钉道组(P<0.05),ASIA分级优于钉道组(P<0.05)。钉道组并发症率高于钉尾组(P<0.05)。结论可灌注骨水泥强化椎弓根螺钉固定术可强化骨质疏松性胸腰椎骨折患者内固定的初始和远期稳定性,可减少椎体高度丢失、保护椎体和神经功能,改善患者生活质量,有较高的安全性。

Objective To compare the curative effects of the treatment of osteoporotic thoracolumbar fracture with the reinforcement of bone cement through the nail tail and the reinforcement of pedicle screw fixation with bone cement through the nail path.Methods From May 2016 to May 2018,86 patients with osteoporotic thoracolumbar fractures who admitted to the orthopaedic department of our hospital were selected,they were divided into two groups according to the order of parity,with 43 cases in each group.In the nail tail group,bone cement reinforced hollow side hole screw fixation was performed.In the nail path group,pedicle screw fixation strengthened by screw cement was performed.All patients were followed up for 12 months.Results There were no significant differences between the two groups in the operation time,intraoperative bleeding,the first time of getting out of bed after operation,the time of hospitalization after operation and the time of fracture healing(P>0.05).The loss height of anterior edge,compression rate of anterior edge,compression rate of posterior edge,Cobb angle,compression area in the nail tail group at the 6th and 12th month after operation were lower than those in the nail path group(P<0.05).The VAS score and ODI index in the nail tail group at 1 month,6 months and 12 months after operation were lower than those in the nail path group(P<0.05),SF-36 scores were all higher than those in the nail path group(P<0.05),and the ASIA grade was better than that in the nail path group(P<0.05).The incidence rate of complications in the nail path group was higher than that in the nail tail group(P<0.05).Conclusion Pedicle screw fixation with bone cement perfusion through the nail tail can enhance the initial and long-term stability of internal fixation,reduce the height loss of vertebral body,protect the vertebral body and nerve function,improve the quality of life of patients,and which has high safety.