摘要
目的 通过与直接椎弓根螺钉内固定术比较,评价用聚甲基丙烯酸甲酯（PM MA）骨水泥强化伤椎的上、下椎体后椎弓根螺钉内固定术治疗骨质疏松性胸腰椎爆裂骨折的疗效. 方法 比较分析2007年1月至2013年8月应用PMMA骨水泥强化伤椎的上、下椎体后椎弓根螺钉内固定术治疗25例（强化组）与直接应用椎弓根螺钉内固定术治疗的32例（直接组）骨质疏松性胸腰椎爆裂骨折患者的疗效.观察并比较两组患者的围手术期相关参数、疼痛缓解程度[视觉模拟评分（VAS）]、功能改善[Oswestry功能障碍指数（ODI）]、并发症发生的情况以及固定节段后凸cobb角、伤椎体前缘高度丢失、椎管内占位等参数. 结果 所有患者术后获平均57.5个月的随访.和直接组相比,强化组的手术时间稍长,但是术后住院时间、腰背痛缓解时间、自主翻身及下床活动时间短,差异均有统计学意义（P＜0.05）.所有患者术后7d、3、6、12、24、36个月的VAS评分、后凸cobb角、ODI、伤椎前缘椎体高度丢失均较术前明显减少,差异有统计学意义（P＜0.05）.和直接组相比,强化组患者术后7d、3、6、12、24、36个月的VAS评分、ODI、后凸cobb角、伤椎前缘椎体高度丢失的改善更好,差异有统计学意义（P＜0.05）.两组患者均没有发生术中神经损伤、肺栓塞、伤口愈合不良等并发症.直接组有5例患者因内固定松动、患者出现腰背痛症状而再次手术取出内固定. 结论 和直接椎弓根螺钉内固定相比,PMMA骨水泥强化椎体后椎弓根螺钉内固定治疗骨质疏松性胸腰椎爆裂骨折疼痛轻、功能恢复好、骨折复位、后凸矫形好,并能防止矫形丢失,是更为理想的骨质疏松性胸腰椎爆裂骨折的手术治疗方法.
Objective To evaluate the curative effects of pedicle screw fixation after vertebroplasty augmentation using polymethylmethacrylate （PMMA） for osteoporotic thoracolumbar burst fractures in comparison with traditional pedicle screw fixation.Methods From January 2007 to August 2013,25 patients with osteoporotic thoracolumbar burst fracture underwent pedicle screw fixation after vertebroplasty augmentation using PMMA （augmentation group） and 32 patients with the same disorder underwent pedicle screw fixation directly （direct group）.The two groups were compared in terms of perioperative indexes,visual analogue scale （VAS）,Oswestry disability index （ODI）,complications,cobb angle of the fixed segment,loss of vertebral body height,and spinal canal encroachment.Results These patients were followed up for an average of 37.5 months.Compared with the direct group,the augmentation group had significantly more perioperative bleeding,shorter hospitalization,shorter time for pain relief and shorter time for ambulatory recovery （P 〈 0.05）.The VAS,ODI,cobb angle of the fixed segment and loss of vertebral body height at 7-day,3-,6-,12-,24-,and 36-month were significantly improved in all the patients （P 〈 0.05）.The augmentation group had significantly better improvements in VAS,ODI,cobb angle of the fixed segment and loss of vertebral body height at 7-day,3-,6-,12-,24-,and 36-month than the direct group （P 〈 0.05）.None of the patients had complications of neural injury,pulmonary thrombosis or poor wound healing.Five patients in the direct group had to receive a second operation to remove the instrumentation due to pedicle screw loosening and back pain.Conclusions In the treatment of osteoporotic thoracolumbar burst fractures,pedicle screw fixation after vertebroplasty augmentation using PMMA can lead to less pain,quicker and better recovery,better fracture reduction and kyphosis correction,and less loss correction than traditional open pedicle screw fixation.
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2015年第6期502-508,共7页
Chinese Journal of Orthopaedic Trauma
