骨密度测量与胸腰椎压缩骨折植入物治疗方式的选择

背景：经皮椎体后凸成形治疗中聚甲基丙烯酸甲酯附着在骨折断端，尽管起到了即刻固定骨折的作用，但也妨碍了纤维组织再生及新骨的形成，从长远角度来说是不利于非骨质疏松骨折愈合。 目的：分析骨密度测定对中老年胸腰椎压缩骨折手术方式及植入物选择的指导意义。 方法：选择单节段胸腰椎压缩骨折患者，根据腰椎L2~4骨密度值测定结果分为骨质疏松组和非骨质疏松组。骨质疏松组行球囊扩张椎体后凸成形治疗，非骨质疏松组行椎弓根钉置入复位内固定治疗。 结果与结论：骨质疏松组3例术中发生骨水泥椎旁渗漏，非骨质疏松组1例患者出现伤口感染。治疗后随访20~28个月，骨质疏松组2例发生邻近椎体骨折，非骨质疏松组内固定物取出后未出现椎体高度丢失、局部后凸角度增大等情况。骨质疏松组手术时间、出血量及术后3 d 目测类比疼痛评分低于非骨质疏松组(P < 0.05)；两组椎体高度和局部后凸角较治疗前恢复显著(P < 0.05)，非骨质疏松组较骨质疏松组更明显(P < 0.05)。表明经皮椎体后凸成形及椎弓根螺钉置入复位内固定均是中老年胸腰椎椎体压缩骨折的理想治疗方法，应根据患者骨质疏松程度采取针对性的治疗方法和植入物，疗效会更加显著。

Implantation material selection based on bone densitometry for thoracolumbar vertebral compression fracture treatment

BACKGROUND:During the course of percutaneous kyphoplasty (PKP), polymethyl methacrylate is injected into vertebrae and attaches in the broken ends of fractured bone, which hinders fibrous tissue regeneration and new bone formation besides of instantly stabilized fracture. In the long run, it is adverse to the healing of non-osteoporosis fracture.    OBJECTIVE:To analysis the guidance of bone densitometry for choosing modus operandi and implantation material in the treatment of thoracolumbar vertebral compression fracture METHODS:Totally 65 patients with single-segment of thoracolumbar compression fracture were divided into two groups according to the L2-4 bone mineral density: osteoporosis group were treated with PKP and non-osteoporosis group were treated with pedicle screw implant and fixation treatment. RESULTS AND CONCLUSION:There were 3 cases of paravertebral cement leakage in the osteoporosis group and 1 case of wound infection in the non-osteoporosis group. The postoperative follow-up ranged 20-28 months. Two patients occurred adjacent vertebral fracture in the osteoporosis group, but no one had vertebral height lost and kyphosis angle increased after fixation removed in the non-osteoporosis group. Operation time, blood loss and the visual analogue scale score in the osteoporosis group were lower as compared with non-osteoporosis group (P < 0.05). Compared with preoperation, both groups had statistical significance in vertebral height restoration and kyphosis angle rectification (P < 0.05), but the non-osteoporosis group was more striking in above indexes (P < 0.05). Both PKP and pedicle screw implant fixation treatment are common methods in treating thoracolumbar vertebral compression fracture of mid-aged patients, and a more significant clinical effect will be received if takes an appropriate operation according to the osteoporosis degree.