椎弓根螺钉固定联合椎体成形术治疗老年骨质疏松性椎体爆裂骨折

摘要

目的：探讨椎弓根螺钉固定联合椎体成形术治疗老年骨质疏松性椎体爆裂骨折的临床效果。方法选取2012年1月～2015年1月收治的单节段胸腰段椎体爆裂骨折患者65例，其中男性31例，女性34例；年龄55～76岁，平均（62.3±4.8）岁。骨折均为高能量打击所致，所有患者合并骨质疏松症，住院期间行椎弓根螺钉固定联合椎体成形手术治疗。结果所有患者顺利完成手术，平均手术时间（83.6±22.7）min，平均术中出血量（328.6±76.5）mL，术后平均住院时间（7.4±1.6）d；随访12～16个月，平均（13.7±2.6）个月，随访期间无严重切口感染、内固定移位或断裂以及椎旁静脉骨水泥栓塞等并发症。出院时和末次随访时患者的视觉模拟评分（ VAS）明显低于术前，差异均有统计学意义（ P＜0.05）。末次随访时患者的健康状况调查简表（SF-36）评分明显高于术前及出院时，差异均有统计学意义（P＜0.05）。术前患者平均Cobb角为（23.4±4.7）°，出院时为（5.3±1.3）°，差异有统计学意义（P＜0.05）；末次随访时为（6.1±2.4）°，增加（0.9±0.2）°，与出院时相比差异有统计学意义（P＜0.05）。术前椎体高度压缩率为（57.5±6.9）％，出院时恢复至（96.4±3.1）％，差异有统计学意义（P＜0.05），末次随访时为（90.8±4.0）％，丢失（5.7±1.1）％，与出院时相比差异有统计学意义（P＜0.05）。结论椎弓根螺钉固定联合椎体成形术治疗老年骨质疏松性椎体爆裂骨折效果显著，术后并发症发生率低，可有效保持伤椎高度，值得临床推广。%Objective To explore the effect of transpedicular fixation combined with vertebral plasty in the treatment of senile thoracolumber burst fracture .Methods Sixty-five cases of senile thoracolumber burst fracture treated in our hospital from Jan.2012 to Jan.2015 were selected.There were 31 males and 34 females,aged from 55 to 76 years,with an average of (62.3 ±4.8) years.All fractures were caused by high energy shock and suffered from osteoporosis .They were treated with transpedicular fixation combined with vertebral plasty .The clinical data was analyzed . Results All operations were performed successfully .The average operation time was ( 83.6 ± 22.7)min;the average bleeding volume was (328.6 ±76.5)mL;and the average postoperative hospitalization time was (7.4 ±1.6)d.There was no serious complication during the follow-up period.The postoperative VAS scores were significantly lower than preoperatively (P<0.05);the postoperative SF-36 scores were significantly lower than preoperatively(P<0.05).The average Cobb angle after operations was (5.3 ±1.3)°,which was significantly lower than preoperatively[(23.4 ±4.7)°,P<0.05]; the Cobb angle at the end of follow-up was (6.1 ±2.4)°,which was (0.9 ±0.2)°higher than immediately after surgery .The vertebral height compression ratio after operation was (96.4 ±3.1)%,which was higher than preoperatively (57.5 ±6.9)%.The vertebral height compression ratio was (90.8 ±4.0)%at the end of follow-up and was decreased by (5.7 ±1.1)%when compared with the value at dis-charge .Conclusion The effect of transpedicular fixation combined with vertebral plasty in the treatment of senile thoracolumber burst fracture is excellent with low complication rate and can effectively restore vetebra height .It is worth clinical application .