椎弓根螺钉结合伤椎成形与结合伤椎固定治疗骨质疏松性胸腰椎爆裂骨折的疗效比较

目的:比较椎弓根螺钉固定结合伤椎成形与椎弓根固定联合伤椎固定在治疗骨质疏松性胸腰椎爆裂性骨折的临床疗效。方法:对2010年8月至2015年8月收治的52例骨质疏松性胸腰椎爆裂性骨折进行回顾性分析,其中采用短节段椎弓根螺钉固定联合伤椎椎体成形术27例(A组),男17例,女10例;年龄54~68(61.01±5.41)岁;新版AO分型,A3型16例,A4型11例。采用短节段椎弓根固定联合伤椎固定25例(B组),男13例,女12例;年龄55~66(59.28±6.12)岁;新版AO分型,A3型18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等。结果:所有患者获得随访,时间12~15(12.4±2.1)个月。两组患者一般资料,包括性别、年龄、损伤部位、术前疼痛视觉模拟评分(VAS评分)、Cobb角、伤椎前缘高度比例差异均无统计学意义。手术时间、术中出血量两组差异无统计学意义。术前、术后1周及末次随访时VAS评分A组分别为5.2±0.5、1.2±0.2、0.8±0.1,B组分别为5.0±0.6、2.5±0.4、1.3±0.2;术前、术后1周及末次随访时伤椎前缘高度比A组分别为(49.4±6.8)%、(94.5±1.2)%、(94.1±3.7)%,B组分别为(48.2±7.0)%、(94.3±4.1)%、(90.0±2.3)%;术前、术后1周及末次随访时Cobb角A组分别为(20.4±5.2)°、(2.5±1.8)°、(4.4±1.7)°,B组分别为(19.8±6.8)°、(2.4±1.7)°、(7.0±1.2)°。两组术前与末次随访上述3项评估结果差异均有统计学意义(P0.05);术后1周及末次随访时A组的VAS评分均较B组低(P0.05);A组Cobb角和伤椎前缘高度比术后1周与末次随访差异无统计学意义(P0.05);B组Cobb角和伤椎前缘高度比在术后1周与末次随访比较差异有统计学意义(P0.05)。A组术后出现1例内固定失败,B组出现4例内固定失败。结论:对骨质疏松性胸腰段椎体爆裂骨折,短节段椎弓根螺钉固定结合伤椎椎体成形比短节段椎弓根固定结合伤椎固定更有利于减少术后疼痛,维持术后伤椎高度和矢状位排列,减少内固定相关并发症,值得推广应用。

Case-control study of pedicle screw fixation combined with vertebroplasty and injured vertebra pedicle fixation in treatment of osteoporotic thoracolumbar burst fractures

Objective:To compare the curative effect of short-segment pedicle screw fixation combined with vertebroplasty and injured vertebra pedicle fixation in treating osteoporotic thoracolumbar burst fractures.Methods:A retrospective study was performed for 52 patients with thoracolumbar burst fractures from August 2010 to August 2015. Among them,27 patients(group A) were treated with short-segment pedicle screw fixation combined with vertebroplasty,including 17 males and 10 females,aged from 54 to 68 years old with an average of(61.01±5.41) years,16 cases were type A3 and 11 cases were type A4 according the new AO typing. Other 25 patients (group B) were treated with short-segment pedicle screw fixation combined with injured vertebra pedicle fixation,including 12 males and 13 females,aged from 55 to 66 years old with an average of (59.28±6.12) years,18 cases were type A3 and 7 cases were type A4 according the new AO typing. Operation time,intraoperative bleeding volume,complication,image data and clinical effect were compared between two groups.Results:All the patients were followed up for 12 to 15 months with an average of (12.4±2.1)months. There was no significant difference in general data(including gender,age,injured site,preoperative VAS score,Cobb angle,injured vertebral anterior border height) between two groups. There was no significant differences in operation time,intraoperative bleeding volume between two groups. Preoperative,one week after operation and final follow-up,VAS scores were 5.2±0.5,1.2±0.2,0.8±0.1 respectively in group A and 5.0±0.6,2.5±0.4,1.3±0.2 in group B; injured vertebral anterior border height were (49.4±6.8)%,(94.5±1.2)%,(94.1±3.7)% respectively in group A and (48.2±7.0)%,(94.3±4.1)%,(90.0±2.3)% in group B;Cobb angles were (20.4±5.2) °,(2.5±1.8) °,(4.4±1.7) ° respectively in group A and (19.8±6.8)°,(2.4±1.7)°,(7.0±1.2)° in group B. At final follow-up,VAS,Cobb angle,injured vertebral anterior border height in two groups were obviously improved(P<0.05). Postoperative at 1 week and final follow-up,VAS score of group A was lower than that of group B(P<0.05);and there was no significant difference in Cobb angle between two groups(P>0.05);there was significant difference in injured vertebral anterior border height between two groups(P<0.05). The complication of internal fixation failure had 1 case in group A and 4 cases in group B.Conclusion:For the treatment of single osteoporotic thoracolumbar burst fractures,short-segment pedicle screw fixation combined with vertebroplasty is better than combined with injured vertebra pedicle fixation in clinical effect,it can relieve pain,maintain injured vertebral height and sagittal alinement,reduce the complications associated with internal fixation,and be worth spread in clinic.