椎体骨折骨不连者的短节段固定与骨水泥螺钉椎体成形术治疗效果

Treatment effect of short segment fixation and cement screw vertebroplasty in vertebral fracture nonunion

目的 探讨短节段固定配合骨水泥螺钉椎体成形术在合并脊神经损伤的陈旧性骨质疏松性椎体骨折骨不连(OOVFN)中的应用。方法 回顾性分析2018年2月—2021年12月于漯河市第三人民医院治疗的合并脊神经损伤的34例OOVFN患者的临床资料,所有患者均接受短节段固定配合骨水泥螺钉椎体形成术。统计患者伤椎骨水泥注入量、术中出血量及手术时间。比较患者术前、术后7 d及末次随访时患者的数字疼痛评分(NRS)、脊髓Oswestry功能障碍(ODI)指数、椎体复位情况及脊髓损伤严重程度,并记录术后并发症情况。结果 患者术中骨水泥注入量为3.48~6.54 mL,平均(5.03±1.08)mL,术中出血量为80~230 mL,平均(156.72±38.49)mL,手术时间为90~130 min,平均(108.40±13.60)min。相较于术前,术后7 d、末次随访时患者的伤椎椎管横截面积更大,后凸Cobb角更小,前缘高度更高,NRS评分及ODI指数均更低,术后7 d及末次随访时Frankel分级D级和E级的占比更显升高,同术后7 d相比,末次随访E级占比更高(P<0.05)。本研究中,术中发生骨水泥向后方椎管渗漏3例,出现局部渗漏6例。无内固定失败、切口感染、神经损伤等情况发生。结论 短节段固定配合骨水泥螺钉椎体成形术对合并神经损伤的OOVFN患者疗效较好,可有效缓解患者疼痛,促进脊髓功能恢复及椎体复位,且患者神经功能恢复较好。

Objective To investigate the application of short segment fixation with cement screw vertebroplasty in old osteoporotic vertebral fracture nonunion(OOVFN) complicated with spinal nerve injury.Methods The clinical data of 34 OOVFN patients treated from February 2018 to December 2021 were retrospectively analyzed, and all patients underwent short segment fixation with cement screw vertebral formation.The amount of injured vertebral cement injection, intraoperative bleeding and operation time were counted.Digital pain score(NRS), spinal Oswestry dysfunction(ODI) index, spinal reduction and SCI severity before, 7 d and last follow-up visits were compared, and postoperative complications were recorded.Results Cement injection was(3.48-6.5)4mL, average(5.03±1.08) mL, intraoperative bleeding was(80-230) mL, average(156.72±38.49) mL, operation time was(90-130) min and average(108.40±13.60) min.Compared to surgery, postoperative 7 d and last cross-up, smaller posterior Cobb angle, higher leading height, lower NRS score and ODI index, higher Frankel grade D and E at 7 d and last follow-up, and higher grade E compared to 7 d(P<0.05).In this study, 3 cases had intraoperative cement leakage to the posterior spinal canal, and local leakage occurred in 6 cases.No internal fixation failure, incision infection, or nerve injury occurred.Conclusion Short segment fixation with cement screw vertebroplasty is effective in OOVFN patients with nerve injury, which can effectively relieve pain, promote spinal cord function recovery and vertebral reduction.