骨水泥强化椎弓根钉内固定术对老年骨质疏松性胸腰椎骨折的疗效

Treatment effect of bone cement enhancement combined with pedicle screw internal fixation in injured vertebrae on osteoporotic thoracolumbar burst fractures in elderly patients

目的 探讨骨水泥强化椎弓根钉内固定术治疗老年骨质疏松性胸腰椎骨折的临床效果。方法 将2015年3月至2020年4月南京中医药大学江阴附属医院收治确诊为老年骨质疏松性胸腰椎骨折的患者90例随机分为对照组(n=45,经伤椎椎弓根钉内固定术治疗),联合组(n=45,骨水泥强化+经伤椎椎弓根钉内固定术治疗)。对比两组疼痛缓解时间、下床活动时间、住院时间和骨折愈合时间;术后疼痛程度(VAS评分)变化;伤椎椎体前缘高度压缩率及Cobb角变化;腰椎功能(ODI评分)变化和术后6个月内并发症发生率。结果 联合组术后在疼痛缓解、平均住院、下床活动及骨折愈合时间均少于对照组,联合组患者术后1 d,术后1、2周、术后1个月VAS评分均低于对照组,联合组患者术后1周、术后3、6个月伤椎椎体前缘高度压缩率均低于对照组,联合组术后3个月和6个月ODI评分均低于对照组,联合组术后6个月并发症率低于对照组(P <0.05)。结论 骨水泥强化联合椎弓根钉内固定术可明显缓解患者术后疼痛,进一步缩短康复时间,矫正患者脊柱畸形,有助于腰椎功能恢复且降低术后并发症的发生率。

Objective To investigate the clinical effect of bone cement enhancement combined with pedicle screw internal fixation in the treatment of elderly osteoporotic thoracolumbar fractures.Methods From March2015 to April 2020,90 patients who were diagnosed with senile osteoporotic thoracolumbar fractures in Jiangyin Hospital of Traditional Chinese Medicine were randomly divided into control group(n = 45,treated with pedicle screw internal fixation of injured vertebra)and combined group(n = 45,treated with bone cement reinforcement +internal fixation of injured vertebral pedicle screw).The pain relief time,out-of-bed activity time,hospital stay and fracture healing time were compared between the two groups;postoperative pain(VAS score)changes;anterior vertebral height compression rate and Cobb angle changes of injured vertebrae,lumbar spine function(ODI score)changes and complication rates within 6 months after surgery in the two groups were compared.Results The postoperative pain relief time,average hospital stay,ambulation and fracture healing time in the combined group were shorter than those in the control group.The VAS scores of the patients in the combined group were lower than those in the control group 1 d,1 week,2 weeks and 1 month after operation.The high compression rate of the leading edge of the injured vertebral body in the combined group was lower than that in the control group 1 week,3 and 6 months after operation.The ODI scores of the patients in the combined group were lower than those in the control group 3 and 6 months after operation.The complication rate 6 months after operation in the combined group was lower than that in the control group(P < 0.05).Conclusion Bone cement enhancement combined with pedicle screw internal fixation can significantly alleviate the postoperative pain of patients,further shorten the recovery time,correct the spinal deformity of patients,and contribute to the recovery of lumbar function and lower incidence of postoperative complications.