单纯椎弓根螺钉固定与伤椎联合骨水泥强化治疗单节段后凸型胸腰椎骨质疏松性骨折的临床疗效研究

Comparison of clinical efficacy of simple pedicle screw fixation and enhanced treatment of injured vertebrae with bone cement in the treatment of single-level kyphotic thoracolumbar osteoporotic fractures

目的比较单纯伤椎邻近节段椎体骨水泥强化椎弓根钉固定与伤椎联合骨水泥强化治疗单节段后凸型胸腰椎骨质疏松性骨折的临床疗效。方法回顾性分析2014年1月至2020年12月该院骨科收治的42例单节段后凸型胸腰椎骨质疏松性骨折患者的临床资料,分为治疗组和对照组,每组21例。治疗组采用骨水泥强化伤椎邻近节段椎体椎弓根钉固定,伤椎双侧关节突融合治疗;对照组单纯伤椎邻近节段椎体骨水泥强化椎弓根钉固定治疗。比较两组患者术前、术后1周、末次随访时视觉模拟疼痛量表(VAS)评分、伤椎前缘高度比值、节段后凸Cobb角、日本骨科学会(JOA)评分,以及并发症发生情况等。42例患者平均随访(45.3±5.4)个月。结果两组患者均未出现切口感染、螺钉断裂松动等并发症,治疗组患者中遗留慢性腰痛2例,对照组患者中遗留慢性腰痛3例,但均较术前有所改善,生活可自理;治疗组患者中发生邻椎骨折1例,对照组患者中发生邻椎骨折2例,均给予PVP治疗后缓解。两组患者术后1周、末次随访时VAS评分、伤椎前缘压缩率、后凸Cobb角、JOA评分均较术前改善,两组患者术后1周、末次随访时VAS评分、伤椎前缘压缩率、后凸Cobb角、JOA评分比较,差异均无统计学意义(P>0.05)。结论伤椎邻近节段椎体骨水泥强化椎弓根钉固定、伤椎双侧关节突植骨融合治疗单节段后凸型胸腰椎骨质疏松性骨折时伤椎做骨水泥强化与不强化术后疼痛的改善、功能的恢复、伤椎高度、后凸Cobb的维持均可达到满意效果,伤椎不用骨水泥强化可缩短手术时间,费用更低。

Objective To investigate the clinical effect of the treatment of single level kyphosis thoracolumbar osteoporotic fracture with vertebral body bone cement and pedicle screw fixation in the adjacent segments of the injured vertebra.Methods The clinical data of 42 patients with single-level kyphotic thoracolumbar osteoporotic fractures admitted to our hospital from January 2014 to December 2020 were retrospectively analyzed.In the treatment group,bone cement was used to strengthen the fixation of the adjacent segments of the injured vertebrae with pedicle nails,and bilateral articular processes of the injured vertebrae were fused.The control group received intensive treatment of injured vertebra with cement on the basis of the treatment group.The visual analogue scale(VAS),the ratio of anterior edge height of injured vertebra,the Cobb Angle of segments kyphotic and the Japanese Orthopaedic Society(JOA)scores were compared between the two groups before surgery,1 week after surgery and at the last follow-up,and the complications were observed.Results For 42 patients(45.3±5.4)months of follow-up,an average of 36.2 months,two groups during the follow-up period such as no incision infection,breakage of screw loosening occurred complications,2 cases in treatment group,control group 3 patients from chronic lumbago,but both preoperative improving,life can provide for oneself,the treatment group,control group 1 case of adjacent vertebral fractures,2 cases of adjacent vertebral fractures All patients were treated with PVP for symptom relief.The pain VAS score,compression rate of anterior edge of injured vertebra,kyphotic Cobb Angle and JOA score in 2 groups at 1 week after surgery and the last follow-up were all improved compared with those before surgery.There was no statistical significance in VAS score,compression rate of anterior edge of injured vertebra,kyphotic Cobb Angle and JOA score between 2 groups at 1 week after surgery and the last follow-up(P>0.05).Conclusion Injury vertebral adjacent segment vertebral bone cement to strengthen the pedicle screw fixation,injured vertebral articular process on both sides of the protruding after treatment of segmental bone graft fusion type thoracolumbar osteoporotic fracture,injury vertebral bone cement reinforcement and reinforcement,the improvement of postoperative pain,functional recovery,after injured vertebral height and convex Cobb,maintain all can achieve satisfied result,injured vertebral without bone cement to strengthen can shorten operation time,It costs less.