经椎弓根椎体内植骨联合短节段内固定术治疗骨质疏松性脊柱骨折的效果观察

Observation on the Effect of Intravertebral Bone Grafting Through Pedicle Combined with Short Segment Internal Fixation in the Treatment of Osteoporotic Spinal Fractures

目的:观察骨质疏松性脊柱骨折患者联合应用短节段内固定术、经椎弓根椎体内植骨术治疗的临床效果。方法:选取阿克苏地区第一人民医院骨科2021年1月—2023年5月接收的骨质疏松性脊柱骨折患者90例,按随机数字表法分组,对照组(n=45)单纯应用短节段内固定术治疗,观察组(n=45)联合应用短节段内固定术、经椎弓根椎体内植骨术治疗。对比两组围手术期指标、术后并发症、伤椎恢复情况[伤椎弯曲角度(Cobb角)、伤椎矢状面指数(VSI)、伤椎前缘高度比(FVHR)、伤椎压缩率]、Oswestry功能障碍指数(ODI)评分、巴氏(Barthel)指数评分、预后优良率。结果:观察组手术时间、围手术期失血量、总住院时间与对照组对比,差异均无统计学意义(P>0.05)。观察组后凸畸形、伤椎愈合延迟、内固定物松脱等并发症发生率比对照组低,差异有统计学意义(P<0.05)。术前,两组Cobb角、VSI、FVHR、伤椎压缩率、ODI评分、Barthel评分对比,差异均无统计学意义(P>0.05);术后6个月,两组VSI、FVHR、Barthel评分均较术前升高,Cobb角、伤椎压缩率、ODI评分均较术前降低,且观察组VSI、FVHR、Barthel评分均较对照组高,观察组Cobb角、伤椎压缩率、ODI评分均较对照组低,差异均有统计学意义(P<0.05)。观察组术后6个月预后优良率比对照组高,差异有统计学意义(P<0.05)。结论:骨质疏松性脊柱骨折患者联合应用短节段内固定术、经椎弓根椎体内植骨术治疗能够进一步减少相关并发症,减轻脊柱功能障碍,提高患者生活质量,促使预后改善,有利于伤椎恢复。

Objective:To observe the clinical effects of combined short segment internal fixation and intravertebral bone grafting through pedicle in the treatment of patients with osteoporotic spinal fractures.Method:A total of 90 patients with osteoporotic spinal fractures from January 2021 to May 2023 in the Department of Orthopedics,Aksu First People's Hospital were selected,they were divided into two groups by random number table method,the control group(n=45)was treated with simple short segment internal fixation surgery,and the observation group(n=45)was treated with a combination of short segment internal fixation surgery and intravertebral bone grafting through pedicle.Perioperative indicators,postoperative complications,and injured vertebra recovery[injured vertebra curvature angle(Cobb angle),vertebral sagittal index(VSI),fractured vertebral anterior height ratio(FVHR),injured vertebra compression rate],Oswestry dysfunction index(ODI)score,Barthel index score,and good prognosis rate were compared between the two groups.Result:There were no differences in surgical time,perioperative blood loss and total hospital stay between the observation group and the control group(P>0.05).The incidence of complications such as kyphosis,delayed healing of the injured vertebra,and loosening of the internal fixation in the observation group was lower compared to that in the control group,the difference was statistically significant(P<0.05).Before surgery,there were no differences in Cobb angle,VSI,FVHR,injured vertebra compression rate,ODI score,and Barthel score between the two groups(P>0.05);after 6 months of surgery,the VSI,FVHR,and Barthel scores of the two groups increased compared to those before surgery,the Cobb angle,injured vertebra compression rate,and ODI score decreased compared to those before surgery,VSI,FVHR and Barthel score in the observation group were higher than those in the control group,while the Cobb angle,injured vertebra compression rate and ODI score in the observation group were lower than those in the control group,the differences were statistically significant(P<0.05).The excellent prognosis rate of the observation group after 6 months of surgery was higher than that of the control group,the difference was statistically significant(P<0.05).Conclusion:The combination of short segment internal fixation and intravertebral bone grafting through pedicle can further reduce related complications,alleviate spinal dysfunction,improve patient quality of life,promote prognosis improvement,and facilitate injured vertebra recovery in patients with osteoporotic spinal fractures.