后路椎弓根钉棒联合椎体成形术治疗老年骨质疏松中重度胸腰椎骨折临床效果

Clinical effect of posterior pedicle screw combined with vertebroplasty in treatment of senile osteoporosis with moderate and severe thoracolumbar fracture

目的研究老年骨质疏松中重度胸腰椎骨折采用后路椎弓根钉棒结合椎体成形术治疗的临床效果。方法回顾性分析2020年3月—2021年4月郑州大学第一附属医院骨科收治的骨质疏松中重度胸腰椎骨折46例老年患者的临床资料,患者均实施后路椎弓根钉棒辅以椎体成形术,采用疼痛视觉模拟评分法(VAS)评估患者术前、术后3 d及末次随访时疼痛程度;经X线像对伤椎椎体前缘高度、受累节段后凸Cobb角进行测量;统计术后并发症发生情况。结果术前、术后3d及末次随访时,VAS评分依次为(5.10±0.94)分、(3.16±0.66)分、(1.10±0.51)分,与手术前对比,术后3 d患者VAS评分明显减少、Cobb角明显下降、伤椎前缘高度比明显提高,差异有统计学意义(P<0.05);末次随访与术后3d比,伤椎前缘高度比有所降低、Cobb角有所增加,但差异无统计学意义(P>0.05);而VAS评分显著减少,差异有统计学意义(P<0.05);术后随访时间均值(13.49±2.61)个月;有2例患者出现骨水泥少量渗漏到椎体前缘,但未压迫脊髓;未发生严重并发症。结论老年骨质疏松中重度胸腰椎骨折联合应用后路椎弓根钉棒、椎体成形术治疗能减轻疼痛、改善脊柱功能,值得临床推广。

Objective To study the clinical effect of posterior pedicle nail rod combined with vertebroplasty in the treatment of senile osteoporosis with moderate and severe thoracolumbar fracture.Methods Clinical data of 46 elderly patients with moderate and severe thoracolumbar fractures of osteoporosis admitted to the Department of Orthopedics of the First Affiliated Hospital of Zhengzhou University from March 2020 to April 2021 were retrospectively analyzed.All patients underwent posterior pedicle nail rod combined with verteboplasty.Visual analogue scale(VAS)was used to evaluate the pain degree of patients before surgery,3d after surgery and at the last follow-up.The height of the anterior margin of the injured vertebra and the Cobb Angle of the affected segment kyphosis were measured by X-ray images.The incidence of postoperative complications was analyzed.Results The VAS score was(5.10±0.94),(3.16±0.66)and(1.10±0.51)before surgery,3 days after surgery and at the last follow-up.Compared with before operation,VAS score,Cobb Angle and anterior vertebrae height ratio of injured vertebrae were significantly decreased in postoperative 3 d patients,with statistical significance(P<0.05).The ratio of anterior height of injured vertebra decreased and the Cobb Angle increased at the last follow-up compared with the postoperative 3 d,but the difference was not statistically significant(P>0.05).VAS score decreased significantly,the difference was statistically significant(P<0.05).The mean follow-up time was(13.49±2.61)months.In 2 patients,a small amount of bone cement leaked to the anterior vertebral margin,but did not compress the spinal cord.No serious complications occurred.Conclusion Combined application of posterior pedicle nail rod and vertebroplasty in the treatment of senile osteoporosis with moderate and severe thoracolumbar fracture can reduce pain and improve spinal function,and is worthy of clinical promotion.