骨水泥强化空心侧孔螺钉固定术与传统椎弓根螺钉固定术治疗胸腰段脊柱骨折患者的效果比较

Comparison of Effect of Bone Cement-reinforced Hollow Lateral Hole Screw Fixation and Traditional Pedicle Screw Fixation in the Treatment of Thoracolumbar Spinal Fracture

目的:比较骨水泥强化空心侧孔螺钉固定术与传统椎弓根螺钉固定术(PSF)治疗胸腰段脊柱骨折(SF)患者的效果。方法:回顾性收集2020年6月-2023年6月厦门市中医院收治的120例胸腰段SF患者的病历资料,按手术方案不同分为观察组(骨水泥强化空心侧孔螺钉固定术,n=60)与对照组(传统PSF,n=60)。比较两组手术效果、影像学指标(伤椎前缘高度比、伤椎Cobb's角)、椎体功能[Oswestry功能障碍指数(ODI)评分]、骨代谢指标[β-胶原降解产物(β-CTX)、骨γ-梭基谷氨酸蛋白(BGP)、骨形态发生蛋白-2(BMP-2)]及并发症发生率。结果:观察组手术优良率为98.33%,较对照组的86.67%高,差异有统计学意义(P<0.05);术后6个月,两组伤椎前缘高度比及血清BGP、BMP-2水平较术前升高,伤椎Cobb's角、ODI评分及血清β-CTX水平较术前降低,且观察组伤椎前缘高度比及血清BGP、BMP-2水平较对照组高,伤椎Cobb's角、ODI评分及血清β-CTX水平较对照组低,差异有统计学意义(P<0.05);观察组并发症发生率为3.33%,较对照组的15.00%低,差异有统计学意义(P<0.05)。结论:相较于传统PSF治疗胸腰段SF患者,骨水泥强化空心侧孔螺钉固定术可进一步提升手术效果,改善椎体功能、骨代谢水平,促进脊柱生理解剖结构恢复,降低并发症发生风险。

Objective:To compare the effect of bone cement-reinforced hollow lateral hole screw fixation and traditional pedicle screw fixation(PSF)in the treatment of thoracolumbar spinal fracture(SF).Method:The medical records of 120 patients with thoracolumbar SF who admitted to Xiamen Hospital of Traditional Chinese Medicine from June 2020 to June 2023 were retrospectively collected,they were divided into the observation group(bone cement-enhanced hollow lateral hole screw fixation,n=60)and the control group(traditional PSF,n=60)according to different surgical schemes.The surgical effect,imaging indexes(height ratio of anterior edge of injured vertebrae,Cobb's angles of injured vertebrae),vertebral function[Oswestry dysfunction index(ODI)score],bone metabolism indexes[β-collagen degradation product(β-CTX),boneγ-spindle glutamate protein(BGP),bone morphogenetic protein-2(BMP-2)]and incidence of complications were compared between two groups.Result:The excellent and good rate of operation in the observation group was 98.33%,which was higher than 86.67%in the control group,and the difference was statistically significant(P<0.05);at 6 months after operation,the height ratio of anterior edge of injured vertebrae and the levels of serum BGP and BMP-2 in two groups were higher than those before operation,and the Cobb's angles of injured vertebrae,ODI scores and serumβ-CTX levels were lower than those before operation,the height ratio of anterior edge of injured vertebrae and the levels of serum BGP and BMP-2 in the observation group were higher than those in the control group,and the Cobb's angle of injured vertebrae,ODI score and serumβ-CTX level were lower than those in the control group,the differences were statistically significant(P<0.05);the incidence of complications in the observation group was 3.33%,which was lower than 15.00%in the control group,and the difference was statistically significant(P<0.05).Conclusion:Compared with traditional PSF in the treatment of thoracolumbar SF patients,bone cement-reinforced hollow lateral hole screw fixation can further improve the surgical effect,improve the vertebral function and the level of bone metabolism,promote the recovery of spinal physiological and anatomical structure,and reduce the risk of complications.