对不同年龄段胸腰椎骨折复位后“空壳”现象的处理

摘要

目的：探讨及分析针对不同年龄段爆裂性胸腰段骨折手术复位后病椎出现“空壳”现象处理的两种方法的临床疗效及应用特点。方法：回顾性分析骨科所治疗的胸腰段爆裂性骨折21例，其中采用后路钉棒复位内固定结合前路钛网融合9例（A 组），采用后路钉棒复位内固定结合椎体后凸成形术（ PKP）12例（B 组），观察手术前后及随访1年后的 VAS 疼痛评分及脊柱后凸 Cobb 角。结果：19例患者获得随访1年，其中 A 组9例，B 组10例（2例患者死亡），所有随访病例均无出现内固定断裂，内固定松动。VAS 评分：A 组术前与术后1周相比，差异有统计学意义（P ＜0.05），术后1周与末次随访相比，差异无统计学意义（P ＞0.05）；B 组术前与术后1周相比，差异有统计学意义（P ＜0.05），术后1周与末次随访相比，差异有统计学意义（P ＜0.05），术前与末次随访相比，差异有统计学意义（P ＜0.05）。Cobb 角测量：A 组术前与术后1周相比，差异有统计学意义（P ＜0.05），术后1周与末次随访相比，差异无统计学意义（ P ＞0.05），B 组术前与术后1周相比，差异有统计学意义（P ＜0.05），术后1周与末次随访相比，差异有统计学意义（ P ＜0.05），术前与末次随访相比，差异有统计学意义（P ＜0.05）。结论：对不同年龄段爆裂性胸腰段骨折，本研究采用的两种治疗方法，术后无出现内固定断裂，内固定松动，患者腰部疼痛轻，椎体高度维持良好，很好地解决了复位后椎体“空壳”现象。同时骨质疏松是我们治疗高龄骨折时千万不能忽视的基础疾病。%Objective To discuss and analyze clinical curative effect and application characteristics of the two treatments for the“shell”phenomenon after the surgery for thoracolumbar burst fracture in the different age groups. Method A retrospective study was conducted to analyze the 21 cases with thoracicolumbar burst fracture,who were treatedin our hospital with two different treatments:Short - segment transpedicular fixation combined with anterior titanium mesh fusion(9 cases,group A)and Short -segment transpedicular fixation combined with PKP(12 cases,group B). The cases were observed before and after the surgery be-side the following 1 year. The VAS pain score system was used to evaluate the patients' pain. The height recovery and kyphotic correction of fracture level were measured by X - ray. Results 19 patients were followed up for 1 year,of which 9 cases were in group A,10 cases were in group B(2 patients were dead). The internal fixations in all the cases were without fracture and loose-ning. The VAS score in group A,there was significant difference between preoperative and postoperative(P < 0. 05),there was no significant difference between postoperative and the last follow - up(P > 0. 05);in Group B compared with preoperative and postoperative 1 week there were significant differences(P < 0. 05),there was significant difference between postoperative 、preop-erative and the last follow - up(P < 0. 05),The Cobb Angle measurement in group A,there was significant difference between preoperative and postoperative(P < 0. 05),there was no significant difference between postoperative and the last follow - up(P> 0. 05);in Group B compared with preoperative and postoperative 1 week there were significant differences(P < 0. 05),there was significant difference between postoperative 、preoperative and the last follow - up(P < 0. 05). Conclusion We treat the tho-racicolumbar burst fracture with different treatments in the different age groups. The internal fixations in all the cases which we observed are without fracture and loosening. The cases have slight pain and the centrums have perfect height. Beside,Osteoporosis is the diseases that we should not ignore in the time we treate senile fractures.