伤椎固定结合成形与跨伤椎固定结合伤椎成形治疗骨质疏松性胸腰椎爆裂骨折的疗效比较

目的:比较伤椎椎弓根固定结合伤椎成形与跨伤椎椎弓根固定结合伤椎成形在治疗骨质疏松性胸腰椎爆裂骨折的临床疗效。方法:收集2015年1月至2017年12月符合纳入标准的骨质疏松性胸腰椎爆裂骨折患者70例,其中35例采用伤椎椎弓根螺钉固定结合伤椎椎体成形术治疗(A组),男20例,女15例;年龄55～74 (64.03±7.82)岁;AO分型A3型26例,A4型9例。其余35例采用短节段跨伤椎椎弓根固定结合伤椎椎体成形术(B组),男18例,女17例;年龄54～72(62.78±6.40)岁;A3型28例,A4型7例。比较两组手术时间、术中出血量、并发症、临床疗效及影像学参数。结果:所有患者随访时间至少12个月;术前两组患者性别、年龄、损伤部位、术前疼痛视觉模拟评分(visual analogue scale,VAS)、Cobb角与伤椎前缘高度比例差异均无统计学意义。两组手术时间、术中出血差异无有统计学意义。术前、术后1周及末次随访时VAS评分:A组分别为(5.5±2.5)、(1.8±0.8)、(0.9±0.4)分,B组分别为(5.4±2.3)、(1.7±0.6)、(1.2±1.8)分;术前、术后1周及末次随访时伤椎前缘高度比例:A组分别为(40.4±8.8)%、(92.0±4.9)%、(87.1±3.8)%,B组分别为(41.2±6.6)%、(93.2±4.6)%、(80.0±4.3)%;术前、术后1周及末次随访时Cobb角:A组分别为(18.4±6.9)°、(2.8±2.2)°、(4.2±2.6)°,B组分别为(16.8±7.2)°、(2.7±2.5)°、(6.0±2.4)°。所有患者术前与末次随访3项评估结果差异均有统计学意义(P0.05);Cobb角和伤椎前缘高度比例术后1周与末次随访差异有统计学意义(P0.05)。A组末次随访伤椎前缘高度比例与B比较差异有统计学意义(P0.05)。A组术后出现2例内固定失败,B组出现4例内固定失败。两组均无神经并发症。结论:对骨质疏松性胸腰段椎体爆裂骨折,伤椎固定结合伤椎椎体成形与单纯结合伤椎成形均能取得良好临床疗效,但伤椎固定结合成形术更有利于维持术后伤椎高度和矢状位排列,减少内固定相关并发症,值得研究应用并推广。

Comparison of the effects of injured vertebra pedicle fixation combined with vertebroplasty and vertebra pedicle screw fixation combined with vertebroplasty in the treatment of osteoporotic thoracolumbar burst fractures

Objective: To assess the curative effects of injured vertebra pedicle fixation combined with vertebroplasty and short-segment pedicle screw fixation combined with vertebroplasty in treatment of osteoporotic thoracolumbar burst fractures.Methods: Seventy patients with osteoporotic thoracolumbar burst fractures who met the inclusion criteria were collected in the study from January 2015 to December 2017. Among them,35 patients were treated with injured vertebra pedicle fixation combined with vertebroplasty (group A),including 20 males and 15 females,aged from 55 to 74 years with an average of (64.03±7.82) years. Twenty-six cases were type A3 and 9 cases were type A4 according to the AO typing;another 35 patients were treated with short-segment pedicle screw fixation combined with vertebroplasty (group B),including 18 males and 17 females,aged from 54 to 72 years with an average of (62.78±6.40) years. Twenty-eight cases were type A3 and 7 cases were type A4 according to AO typing. Operation length,intraoperative bleeding volume,complication,imaging parameters and clinical effects were compared between the two groups.Results: All the patients were followed up for at least 12 months. There were no significant differences in gender,age,injury site,preoperative VAS,Cobb angle,and injured vertebral height before surgery. There were no significant differences in operation length,intraoperative bleeding volume between two groups. In terms of VAS scores before surgery,1 week after surgery,and at the final follow-up,group A was 5.5±2.5,1.8±0.8,0.9±0.4,group B was 5.4±2.3,1.7±0.6,1.2±1.8,respectively;injured vertebral height was(40.4±8.8)%,(92.0±4.9)%,(87.1±3.8)% in group A,and(41.2±6.6)%,(93.2±4.6)%,(80.0±4.3)% in group B;Cobb angle was (18.4±6.9)°,(2.8±2.2)°,(4.2±2.6)° in group A,and (16.8±7.2)°,(2.7±2.5)°,(6.0±2.4)° in group B. There were significant differences in the 3 parameters above before the operation and at the final follow-up in all groups(P<0.05). There were significant differences in the Cobb angle and injured vertebral height between 1 week after operation and at the final follow-up(P<0.05). At the final follow-up,injured vertebral height in group A was obviously better than that in group B(P<0.05). Internal fixation failure occurred in 2 cases from the group A,and occurred in 4 cases from the group B. There were no neurological complications in both groups.Conclusion: For osteoporotic thoracolumbar vertebral burst fractures,injured vertebra pedicle fixation combined with vertebroplasty and vertebra pedicle screw fixation combined with vertebroplasty can achieve good clinical effects. However,injured vertebra pedicle fixation combined with vertebroplasty is better at maintaining postoperative vertebral height and sagittal arrangement,and reducing internal fixation-related complications. The treatment strategy is worthy of application and promotion.