摘要
目的探讨椎弓根螺钉内固定配合经皮椎体成形术(PVP)治疗骨质疏松性胸腰椎骨折的临床疗效及术后再骨折的影响。方法我院收治的60例骨质疏松性胸腰椎骨折患者,按区化随机法分为联合组和对照组各30例,对照组行单纯PVP,联合组行椎弓根螺钉内固定+PVP,对比两组一般手术资料,采用视觉模拟疼痛评分(VAS)、Oswetry功能障碍指数(ODI)评价疼痛及功能障碍改善情况,行X射线平片观察术后椎体压缩率、椎体高度恢复率、后凸角恢复情况及后凸角矫正率,并统计术后再骨折发生率。结果两组术中骨水泥注入量比较差异无统计学意义(P>0.05),联合组手术时间、出院时间长于对照组,术中输血量多于对照组(P<0.05);两组术后VAS评分、ODI显著下降(P<0.05),但组间比较差异无统计意义(P>0.05),术后1月时,联合组VAS评分及ODI低于对照组(P<0.05);术后即刻、1月、3月时,联合组椎体高度压缩率低于对照组、后凸角角度小于对照组,椎体高度恢复率及后凸角矫正率优于对照组(P<0.05),随访期内联合组无再骨折发生,对照组发生再骨折4例、毗邻椎体骨折7例。结论椎弓根螺钉内固定配合+PVP治疗骨质疏松性胸腰椎骨折疗效更佳,可有效防止PVP术后再骨折。
Objective To investigate the clinical curative effect of pedicle screw fixation combined with percutaneous vertebroplasty(PVP)in the treatment of osteoporotic thoracolumbar fractures and the influence on postoperative re-fracture.Methods Sixty patients with osteoporotic thoracolumbar fractures treated in our hospital were randomly divided into combined or control group,30 in each group.The control group was treated with PVP only while the combined group was treated with pedicle screw fixation+PVP.The general surgical data were compared between the two groups.The relief of pain and dysfunction was evaluated with the visual analogue scale(VAS)and Oswetry disability index(ODI).The rate of postoperative vertebral compression,vertebral height recovery,kyphosis angle recovery and correction rate of the kyphosis angle were observed with X-ray examination.The incidence of postoperative re-fracture was statistically analyzed.Results There was no significant difference in the injected volume of bone cement during operation between the two groups(P>0.05).However,the surgical time and discharge time of the combined group was longer than that of the control group,and the intraoperative blood transfusion volume was larger than that of the control group(P>0.05).VAS and ODI scores of both groups were decreased significantly after surgery(P>0.05),but the VAS and ODI scores of the combined group were significantly lower than those of the control group(P>0.05).The rate of vertebral body height compression in the combined group was lower than that in the control group and the kyphosis angle was significantly smaller than that in the control group immediately after surgery,1 month and 3 months after surgery.The recovery rate and correction rate of the kyphosis angle in the combined group were better than those in the control group at different time points(P>0.05).No re-fractures occurred in the combined group during the follow-up period.However,there were 4 cases of re-fractures and 7 cases of adjacent vertebral fractures in the control group.Conclusion Pedicle screw fixation combined with PVP is effective in the treatment of osteoporotic thoracolumbar fractures.It can effectively prevent re-fractures after PVP.
作者
梁本高
王国辉
LIANG Ben-gao;WANG Guo-hui(Department of Orthopedics,Qionglai Medical Center Hospital,Chengdu 611530,China)
出处
《实用医院临床杂志》
2019年第5期212-215,共4页
Practical Journal of Clinical Medicine
关键词
椎弓根螺钉内固定
经皮椎体成形术
骨质疏松性胸腰椎骨折
术后再骨折
Pedicle screw fixation
Percutaneous vertebroplasty
Osteoporotic thoracolumbar fracture
Postoperative re-fracture
