急性症状性骨质疏松性胸腰椎骨折分型Ⅳ型患者短节段和长节段固定的临床疗效比较

Clinical comparison of type Ⅳ short and long segment fixation for acute symptomatic osteoporotic thoracolumbar fractures

中文关键词:  ASOTLF分型  骨质疏松  脊柱骨折  胸椎  腰椎

英文关键词:ASOTLF classification  Osteoporosis  Spinal fracture  Thoracic vertebra  Lumbar vertebra

中文摘要:

  【摘要】 目的：比较急性症状性骨质疏松性胸腰椎骨折（acute symptomatic osteoporotic thoracolumbar fracture，ASOTLF）分型Ⅳ型短节段和长节段固定的临床疗效。方法：回顾性分析2016年1月～2019年12月在我院收治的骨质疏松性胸腰椎骨折患者临床资料，参照ASOTLF分型符合Ⅳ型的为35例。将其按照固定节段的长短进行分组，A组为短节段组（以伤椎为中心，固定节段包含伤椎及上下各1个正常椎节）；B组为长节段固定组（以伤椎为中心，固定节段包含伤椎及上下各2个正常椎节）；手术方式为：A组患者伤椎进行骨水泥强化并进行螺钉固定，伤椎上下椎体进行椎弓根螺钉固定并进行钉道强化；B组患者伤椎进行骨水泥强化及螺钉固定，同时进行伤椎上下各两组椎弓根螺钉固定并进行钉道强化；两组手术都进行后方固定节段范围内小关节突关节植骨融合；其中A组18例，男6例，女12例，年龄72．1±3．5岁，腰椎骨密度T值－3．2±0．2，随访时间12．0±3．3个月；B组17例，男 7 例，女10例，年龄72．4±3．5岁，腰椎骨密度T值－3．1±0．4，随访时间15．3±2．8个月。比较两组患者的性别、年龄、随访时间、手术时间、术中出血量、骨水泥渗漏、邻椎骨折率，以及手术前后的疼痛视觉模拟评分（visual analogue scale，VAS）、Oswestry功能障碍指数（Oswestry disability index，ODI）、后凸角变化，记录并发症。结果：术前两组患者年龄、性别、骨密度T值、疼痛VAS评分、ODI、后凸角比较差异无统计学意义（P＞0.05），手术时间（63．7±10．6min vs 93．5±12．1min）及术中出血量（205．3±28．4ml vs 326．0±37．9ml）A组少于B组，术后7d及末次随访时两组患者的疼痛VAS评分、ODI、后凸角较术前均有显著改善（P＜0.05），组间比较差异无统计学意义（P＞0.05）。两组骨水泥渗漏（4/18 vs 3/17）及其他椎体骨折发生（2/18 vs 1/17）情况无统计学差异（P＞0.05）。结论：急性症状性骨质疏松性胸腰椎骨折分型Ⅳ型选择后路短节段或长节段固定，都能达到较满意的伤椎复位、临床疗效和畸形矫正，短节段固定在手术时间及术中出血上更具优势。

英文摘要:

  【Abstract】 Objectives: To compare the clinical efficacy of type Ⅳ short segment fixation and long segment fixation in acute symptomatic osteoporotic thoracolumbar fracture(ASOTLF). Methods: Clinical data of patients with osteoporotic thoracolumbar fracture(OTLF) admitted to our hospital from January 2016 to December 2019 were retrospectively analyzed by ASOTLF classification, among which 35 cases were classified as type Ⅳ. They were divided into two groups according to the length of fixed segments. Group A was the short segment fixation group(the injured vertebrae and its upper and lower one normal segment), and group B was the long segment fixation group(the injured vertebrae and its upper and lower 2 normal segments). In group A, the injured vertebrae were reinforced with bone cement, followed by pedicle screw fixation and nail channel reinforcement in both upper and lower vertebrae. In group B, the injured vertebrae were strengthened with bone cement and screw fixation, and two groups of pedicle screws were fixed on the upper and lower vertebrae, and the screw channel was strengthened. In both groups, posterior fixed segmental facet joint bone graft fusion was performed. In group A, there were 18 patients, 6 males and 12 females, aged 72.1±3.5 years, were followed up for 12.0±3.3 months with the T-value of lumbar bone mineral density(BMD) of -3.2±0.2. There were 17 patients in group B, including 7 males and 10 females, aged 72.4±3.5 years, the T-value of lumbar BMD was -3.1±0.4, and the follow-up time was 15.3±2.8 months. The gender, age, follow-up time, operation time, intraoperative blood loss, bone cement leakage, adjacent vertebral fracture rate, visual analogue scale(VAS), Oswestry disability index(ODI) and kyphotic angle changes before and after surgery were compared between the two groups, and complications were recorded. Results: There were no statistically significant differences in age, gender, BMD T-value, VAS score, ODI, and kyphotic angle between the two groups before surgery(P＞0.05); the operation time(63．7±10．6min vs 93．5±12．1min) and intraoperative blood loss(205．3±28．4ml vs 326．0±37．9ml) in group A were less than those in group B; the VAS score, ODI, and kyphotic angle of the two groups were significantly improved at 7 days after surgery and at final follow-up(P＜0.05) than those before operation, and there was no significant difference between groups(P＞0.05). No significant difference was found in cement leakage(4/18 vs 3/17) and other vertebral fractures(2/18 vs 1/17) between the two groups. Conclusions: In type Ⅳ acute symptomatic osteoporotic thoracolumbar fracture, short-segment or long-segment posterior fixation can both achieve satisfactory reduction, clinical efficacy and deformity correction of injured vertebrae. Short-segment fixation has more advantages in operative time and intraoperative bleeding.