椎弓根螺钉短节段固定联合椎体成形术治疗单节段胸腰段骨质疏松性椎体爆裂骨折

Short-segment transpedicular fixation combined with vertebroplasty for thoracolumbar burst fractures in patients with osteoporosis

中文关键词:  椎弓根螺钉  椎体成形  骨质疏松  胸腰段  爆裂性骨折

英文关键词:Pedicle screw  Vertebroplasty  Osteoporosis  Thoracolumbar  Burst fracture

中文摘要:

  【摘要】 目的：探讨椎弓根螺钉短节段固定联合椎体成形术治疗单节段胸腰段骨质疏松性椎体爆裂骨折的临床疗效。方法：回顾性分析我院2008年1月～2012年3月收治的86例单节段胸腰段爆裂椎体骨折患者的临床资料，对其中32例合并骨质疏松症的患者进行随访分析。男14例，女18例；年龄56～78岁，平均64.5岁；跌倒伤14例，车祸伤9例，高处坠落伤5例，重物砸伤4例；骨折节段：T11 3例；T12 10例；L1 15例；L2 4例。手术时均在骨折上下椎置入椎弓根螺钉，安装连接棒，通过体位结合撑开实现骨折椎体复位，然后在伤椎注入骨水泥。应用VAS及SF-36量表评估患者疼痛及生活质量改变情况，通过X线片测量计算伤椎椎体前缘高度恢复、受伤节段后凸矫正及丢失情况，随访观察治疗效果。结果：所有患者均顺利完成手术，术中无明显并发症。随访12～36个月，平均16.5个月。术后VAS评分（2.43±1.81分）及末次随访时VAS评分（2.17±1.81分）与术前（7.67±2.25分）比较差异有统计学意义（P<0.05）；末次随访SF-36评分（123.5±22.3分）与术前（95.7±17.5分）比较差异有统计学意义（P<0.05）。术前Cobb角为22.3°±3.6°，术后Cobb角矫正至5.2°±1.2°，末次随访时为6.0°±2.3°，丢失0.8°±1.5°；术前椎体高度（56.4±5.8）%，术后椎体高度恢复至（95.3±2.9）%，末次随访时为（91.4±3.7）%，丢失（4.0±2.5）%。3例出现椎旁静脉骨水泥栓塞，无明显症状，无内固定断裂。结论：后路短节段椎弓根螺钉固定联合椎体成形术能够有效恢复并维持伤椎高度，减少后凸畸形矫正丢失及内固定失败的发生，具有良好的疗效。

英文摘要:

  【Abstract】 Objectives： To evaluate the effect of short-segment transpedicular fixation combined with vertebroplasty for thoracolumbar burst fractures in patients with osteoporosis. Methods: The clinical data of thoracolumbar burst fractures of 86 patients from January 2008 to March 2012 were analyzed retrospectively. There were 32 cases accompanied by osteoporosis including 14 males and 18 females with a mean age of 64.5(range, from 56 to 78 years old). The mechanisms of injuries were fall in 14 cases, traffic accident in 9 cases, high falling in 5 cases and heavy pound injury in 4 cases. The involved vertebrae included T11(3 cases), T12(10 cases), L1(15 cases) and L2(4 cases). Fractures were reduced with pedicle screw system followed by vertebroplasty. VAS and SF-36 scoring systems were used to evaluate the patients′ pain and life quality. The height recovery and kyphotic correction of fracture level were measured by X-ray. Results: All patients underwent surgery safely without severe complications occurred. The average follow-up time was 16.5 months(range, 12-36 months). There was significant difference(P<0.05) in VAS score at final follow-up(2.17±1.81) and post-operation(2.43±1.81) compared with pre-operation(7.67±2.25), respectively. And also there was significant difference(P<0.05) in SF-36 score between final follow-up(123.5±22.3) and post-operation(95.7±17.5). The Cobb angle recovered to 5.2°±1.2° of post-operation and 6.0°±2.3° of final follow-up, with a loss of 0.8°±1.5°. The vertebra height improved to (95.3±2.9)% of post-operation and (91.4±3.7)% of final follow-up, with a loss of(4.0±2.5)%. The asymptomatic bone cement intravenous leakage occurred in 3 patients. There was no breakage of internal fixations. Conclusions: Short-segment transpedicular fixation combined with vertebroplasty is a safe and effective management due to its less loss of correction and instrument failure.