75例骨质疏松性胸腰椎骨折手术治疗的临床疗效研究

Study on the clinical efficacy of surgical treatment of 75 patients with osteoporotic thoracolumbar fractures

目的 分析手术治疗在骨质疏松性胸腰椎骨折病患中的应用价值。方法 回顾性选取2018年1月到2020年1月收治的75例需进行治疗的骨质疏松性胸腰椎骨折患者为研究对象,并按照治疗方式的不同将其分为单独组(40例)、联合组(35例)。单独组:单一采用经皮椎体成形术;联合组:在单独组基础上联合经皮椎弓根螺钉内固定术,所有患者需持续治疗及观察3个月,并将2组患者各项指标数据进行统计分析。结果 联合组手术时间[(74.71±6.35)min]、住院时间[(5.31±0.82)d]均明显长于单独组[(42.19±4.65)min、(3.27±0.79)d],差异均有统计学意义(P<0.05)。联合组出血量[(36.76±0.23)mL]、骨水泥注入量[(5.81±1.07)mL]明显多于单独组[(11.31±0.34)、(3.84±1.01)mL],差异有统计学意义(P<0.05)。2组术前VAS、ODI评分无明显差异,术后3个月2组VAS、ODI评分较术前均呈下降趋势,且联合组VAS、ODI评分[(1.51±0.62)、(11.25±2.19)分]较单独组[(2.03±0.98)、(18.65±2.25)分]均更低(P<0.05)。术前2组椎体压缩率无差异(P>0.05),术后3个月2组椎体压缩率较术前均呈下降趋势,且联合组椎体压缩率较单独组更低[(23.31±3.64)%vs.(37.42±4.07)%,P<0.05]。术后3个月联合组、单独组椎体高度恢复率分别为(62.14±4.17)%、(46.85±3.71)%,较术前均呈上升趋势,且联合组较单独组更高(P<0.05)。术后3个月联合组并发症总发生率(8.57%)较单独组(27.50%)更低(P<0.05)。结论 经皮椎弓根螺钉内固定联合经皮椎体成形术能够促进骨质疏松性胸腰椎骨折患者功能障碍恢复,并提升其椎体压缩率及椎体高度恢复率,减轻疼痛,降低并发症发生风险。

Objective To analyze the application value of surgical treatment in patients with osteoporotic thoracolumbar fractures.Methods A total of 75 patients with osteoporotic thoracolumbar fractures who needed treatment from January 2018 to January 2020 were retrospectively selected as the study objects,and were divided into single group(40 cases)and combined group(35 cases)according to different treatment methods.Only percutaneous vertebroplasty was performed in the single group.The combined group on the basis of separate groups combined percutaneous pedicle screw fixation,all patients need continuous treatment and observation for three months,and the index data of patients in the two groups were statistically compared and analyzed.Results The operation time and hospital stay of combined group were(74.71±6.35)min and(5.31±0.82)d,which were significantly longer than those in the single group[(42.19±4.65)min and(3.27±0.79)d],and the differences were statistically significant(P<0.05).The amount of blood loss(36.76±0.23)mL and the amount of bone cement injection(5.81±1.07)mL in the combination group were significantly higher than those in the single group[(11.31±0.34)mL and(3.84±1.01)mL],and the differences were statistically significant(P<0.05).There was no significant difference in VAS and ODI scores between the two groups before operation.At 3 months after operation,VAS and ODI scores of the two groups showed a downward trend compared with those before operation.Moreover,the scores of combined group[(1.51±0.62),(11.25±2.19)min]were lower than those in the single group[(2.03±0.98),(18.65±2.25)min](P<0.05).There was no difference in vertebral body compression ratio between the two groups before surgery operation(P>0.05).At threee months after operation,the vertebral body compression ratio between the two groups showed a downward trend compared with that before operation,and the vertebral body compression ratio of the combined group was lower than that of the single group[(23.31±3.64)%vs.(37.42±4.07)%,P<0.05].At three months after surgery,the recovery rates of vertebral body height in the combined group and the single group were(62.14±4.17)%and(46.85±3.71)%,respectively,which showed an upward trend compared with those before operation,and the recovery rates in combination group were higher than those in single group(P<0.05).Three months after surgery,the overall complication rate of combination group(8.57%)was lower than that of single group(27.50%)(P<0.05).Conclusion Percutaneous pedicle screw fixation combined with percutaneous vertebroplasty can promote the recovery of dysfunction in patients with osteoporotic thoracolumbar fractures,increase the rate of vertebral compression and vertebral height recovery,relieve pain and reduce the risk of complications.