球囊扩张硫酸钙骨水泥椎体增强与后外侧植骨融合结合短节段经伤椎椎弓根钉固定治疗胸腰椎爆裂性骨折疗效比较

摘要

目的 分析比较球囊扩张硫酸钙骨水泥(Calcium sulfate cement,CSC)椎体增强与后外侧植骨融合结合短节段经伤椎椎弓根钉固定治疗胸腰椎爆裂性骨折中的临床效果.方法 选取本院2012年1月～2014年12月经临床确诊为胸腰椎爆裂性骨折的60例患者,随机分成两组,各30例.椎体增强组患者采用球囊扩张CSC椎体增强结合短节段经伤椎椎弓根钉内固定;植骨融合组应用后外侧植骨融合结合短节段经伤椎椎弓根钉内固定.分别记录两组患者术前、术后1周及末次随访时视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、伤椎中央高度比、矢状面Cobb角等指标,并对结果进行比较和统计学分析.结果 与术前相比,术后两组患者的VAS得分和ODI分值均显著降低,术后疼痛情况明显改善(P＜0.01);术后1年,椎体增强组的中央高度比均明显高于植骨融合组且术后1年椎体增强组的矢状面Cobb角远远小于植骨融合组,提示术后椎体增强组疗效优于植骨融合组,矫正丢失更少,差异均存统计学意义(P＜0.01),所有患者均未出现内固定失败.结论 球囊扩张CSC椎体增强与后外侧植骨融合均可有效治疗胸腰椎爆裂性骨折,但CSC椎体增强早期可更好的恢复伤椎的高度,增加伤椎的稳定性和椎体强度,减少矫正度丢失,保留脊柱的节段运动功能.%Objective To compare the clinical curative effects of balloon vertebroplasty reinforced by injectable calcium sulfate cement (CSC) and posterolateral fusion after short-segment pedicle screw fixation through the fractured vertebra in treatment ofthoracolumbar burmt fractures.Methods 60 cases ofthoracolumbar burst fracture were randomly divided into two groups in our hospital in Jan 2012 to Dec 2014,each group had 30 cases,and one group were treated by balloon expansion vertebral body enhancement combined with short segmental injury vertebral pedicle screw internal fixation,and the others underwent posterolateral fusion in addition to short-segment pedicle screw fixation through the fractured vertebr.The two groups were compared at preoperation,1 week postoperation and the last follow-up in terms of visual analogue scale (VAS),Oswestry disability index (ODI),middle height ratio of the injured vertebra and the sagittal Cobb angle.Results Compared with the preoperative,two groups of patients with postoperative VAS scores and ODI scores were significantly lower,postoperative pain situation improved significantly (P＜0.01);After 1 year,vertebral body height than in the middle of the enhanced group were significantly higher than bone graft fusion and vertebral strengthening postoperative 1 year group of sagittal Cobb Angle of bone graft fusion was much higher than group,prompt postoperative vertebral body to enhance curative effect was better than that of bone graft fusion group,rectify lost less,the differences were statistically significant (P＜0.01),all no internal fixation failure occurred.Conclusion CSC balloon expansion vertebral body enhancement and posterolateral bone graft fusion are effective treatment ofthoracolumbar burst fracture,but CSC vertebral strengthening early can better recovery of injured vertebral height,increase the stability of injured vertebral and vertebral body strength and reduce the correct degree of loss,preserved section of the spinal movement function.