Jiang Wei-Yu, Ma Wei-Hu, Zhao Hua-Guo, Hu Xu-Dong, Chen Yun-Ling, Xu Nan-Jian, Ruan Chao-Yue
Department of Spinal Surgery, Ningbo No.6 Hospital, Ningbo 315040, Zhejiang, China.
Department of Spinal Surgery, Ningbo No.6 Hospital, Ningbo 315040, Zhejiang, China;
Zhongguo Gu Shang. 2018 Aug 25;31(8):703-708. doi: 10.3969/j.issn.1003-0034.2018.08.004.
To compare the curative effect of short-segment pedicle screw fixation combined with vertebroplasty and injured vertebra pedicle fixation in treating osteoporotic thoracolumbar burst fractures.
A retrospective study was performed for 52 patients with thoracolumbar burst fractures from August 2010 to August 2015. Among them, 27 patients(group A) were treated with short-segment pedicle screw fixation combined with vertebroplasty, including 17 males and 10 females, aged from 54 to 68 years old with an average of(61.01±5.41) years, 16 cases were type A3 and 11 cases were type A4 according the new AO typing. Other 25 patients (group B) were treated with short-segment pedicle screw fixation combined with injured vertebra pedicle fixation, including 12 males and 13 females, aged from 55 to 66 years old with an average of (59.28±6.12) years, 18 cases were type A3 and 7 cases were type A4 according the new AO typing. Operation time, intraoperative bleeding volume, complication, image data and clinical effect were compared between two groups.
All the patients were followed up for 12 to 15 months with an average of (12.4±2.1)months. There was no significant difference in general data(including gender, age, injured site, preoperative VAS score, Cobb angle, injured vertebral anterior border height) between two groups. There was no significant differences in operation time, intraoperative bleeding volume between two groups. Preoperative, one week after operation and final follow-up, VAS scores were 5.2±0.5, 1.2±0.2, 0.8±0.1 respectively in group A and 5.0±0.6, 2.5±0.4, 1.3±0.2 in group B; injured vertebral anterior border height were (49.4±6.8)%, ( 94.5±1.2)%, ( 94.1±3.7)% respectively in group A and (48.2±7.0)%, ( 94.3±4.1)%, ( 90.0±2.3)% in group B;Cobb angles were (20.4±5.2) °, (2.5±1.8) °, (4.4±1.7)° respectively in group A and (19.8±6.8)°, (2.4±1.7)°, (7.0±1.2)° in group B. At final follow-up, VAS, Cobb angle, injured vertebral anterior border height in two groups were obviously improved(<0.05). Postoperative at 1 week and final follow-up, VAS score of group A was lower than that of group B(<0.05);and there was no significant difference in Cobb angle between two groups(>0.05); there was significant difference in injured vertebral anterior border height between two groups(<0.05). The complication of internal fixation failure had 1 case in group A and 4 cases in group B.
For the treatment of single osteoporotic thoracolumbar burst fractures, short-segment pedicle screw fixation combined with vertebroplasty is better than combined with injured vertebra pedicle fixation in clinical effect, it can relieve pain, maintain injured vertebral height and sagittal alinement, reduce the complications associated with internal fixation, and be worth spread in clinic.
比较短节段椎弓根螺钉固定联合椎体成形术与伤椎椎弓根固定治疗骨质疏松性胸腰椎爆裂骨折的疗效。
回顾性分析2010年8月至2015年8月收治的52例胸腰椎爆裂骨折患者。其中，27例患者（A组）采用短节段椎弓根螺钉固定联合椎体成形术治疗，男17例，女10例，年龄54～68岁，平均（61.01±5.41）岁，根据新AO分型，A3型16例，A4型11例。另外25例患者（B组）采用短节段椎弓根螺钉固定联合伤椎椎弓根固定治疗，男12例，女13例，年龄55～66岁，平均（59.28±6.12）岁，根据新AO分型，A3型18例，A4型7例。比较两组手术时间、术中出血量、并发症、影像学资料及临床疗效。
所有患者均随访12～15个月，平均（12.4±2.1）个月。两组一般资料（包括性别、年龄、受伤部位、术前视觉模拟评分法（VAS）评分、Cobb角、伤椎前缘高度）比较差异无统计学意义。两组手术时间、术中出血量比较差异无统计学意义。术前、术后1周及末次随访时，A组VAS评分分别为5.2±0.5、1.2±0.2、0.8±0.1，B组分别为5.0±0.6、2.5±0.4、1.3±0.2；A组伤椎前缘高度分别为（49.4±6.8）%、（94.5±1.2）%、（94.1±3.7）%，B组分别为（48.2±7.0）%、（94.3±4.1）%、（90.0±2.3）%；A组Cobb角分别为（20.4±5.2）°、（2.5±1.8）°、（4.4±1.7）°，B组分别为（19.8±6.8）°、（2.4±1.7）°、（7.0±1.2）°。末次随访时，两组VAS、Cobb角、伤椎前缘高度均明显改善（P<0.05）。术后1周及末次随访时，A组VAS评分低于B组（P<0.05）；两组Cobb角比较差异无统计学意义（P>0.05）；两组伤椎前缘高度比较差异有统计学意义（P<0.05）。A组内固定失败并发症1例，B组4例。
对于单节段骨质疏松性胸腰椎爆裂骨折的治疗，短节段椎弓根螺钉固定联合椎体成形术临床疗效优于联合伤椎椎弓根固定，能缓解疼痛，维持伤椎高度及矢状面序列，减少内固定相关并发症，值得临床推广。
