骨水泥强化椎弓根螺钉固定治疗骨质疏松性胸腰椎骨折的临床效果观察

发布时间：2018-04-27 09:09

本文选题：骨质疏松性骨折 + 脊柱骨折　；参考：《解放军医学杂志》2017年01期

【摘要】：目的评价骨水泥强化椎弓根螺钉固定治疗骨质疏松性胸腰椎骨折的临床效果。方法对2013年6月-2014年12月收治的53例骨质疏松性胸腰椎骨折患者进行骨水泥强化椎弓根螺钉固定治疗,所有患者术前骨密度检测T值均≤ 2.5,术中均于伤椎邻近椎体注射1.5ml骨水泥强化椎弓根螺钉,术前和术后均给予抗骨质疏松治疗。观察和记录患者围术期基本情况及并发症发生情况。记录术前、术后1周和末次随访时患者疼痛视觉模拟评分(VAS)和神经功能情况(ASIA分级),测量术前、术后1周和末次随访时的伤椎前缘压缩率、伤椎后缘压缩率、椎管狭窄率和Cobb角。结果53例患者均顺利完成手术,手术时间90~140min,出血量150~350ml;术中无神经损伤,无硬膜撕裂,无明显骨水泥渗漏和螺钉松动。所有患者均获随访,随访时间12~30个月。患者术后神经功能较术前有明显恢复。末次随访X线片及CT示椎体骨折均愈合,内固定位置良好,未见明显松动迹象,未见明显骨水泥渗漏。术后1周和末次随访时的VAS评分、伤椎前缘压缩率、伤椎后缘压缩率、椎管狭窄率、Cobb角与术前比较差异均有统计学意义(P0.05),而术后1周与末次随访时比较差异均无统计学意义(P0.05)。结论骨水泥强化椎弓根螺钉固定术能有效强化骨质疏松条件下内固定的初始稳定性,恢复骨折椎体的高度,减轻椎管内压迫,有利于后凸畸形的矫正和神经功能的恢复,并能很好地维持骨质疏松条件下内固定的远期稳定性和骨折椎体的高度,显著降低了远期螺钉松动和椎体塌陷的风险。
[Abstract]:Objective to evaluate the clinical effect of cement-reinforced pedicle screw fixation in the treatment of osteoporotic thoracolumbar fractures. Methods from June 2013 to December 2014, 53 patients with osteoporotic thoracolumbar fractures were treated with cement reinforced pedicle screw fixation. Preoperative bone mineral density (BMD) of all patients was less than 2.5. 1.5ml cement was injected into the injured vertebrae to reinforce pedicle screw during the operation, and anti-osteoporosis treatment was given before and after operation. To observe and record the basic situation and complications of patients during perioperative period. The visual analogue score of pain (VAS) and neurological function were recorded before, 1 week and the last follow-up. The compression ratio of the anterior edge of the injured vertebrae and the posterior edge of the injured vertebra were measured before, 1 week and the last follow-up. Spinal stenosis rate and Cobb angle. Results the operation was completed successfully in 53 patients, the operative time was 90 ~ 140 min, the blood loss was 150 ~ 350 ml, there was no nerve injury, no dura tear, no obvious bone cement leakage and screw loosening during the operation. All patients were followed up for 12 ~ 30 months. The neurological function of the patients recovered significantly after operation. At the last follow-up, X-ray and CT showed that the vertebral fracture healed, the internal fixation position was good, there was no obvious loosening and no obvious bone cement leakage. There were significant differences in VAS score, anterior compression ratio of injured vertebrae, compression ratio of posterior edge of injured vertebrae and spinal canal stenosis rate between 1 week and the last follow-up after operation (P 0.05), but there was no significant difference between 1 week after operation and at the last follow-up (P 0.05). Conclusion Cement-enhanced pedicle screw fixation can effectively enhance the initial stability of internal fixation under osteoporosis, restore the height of fracture vertebral body, reduce the compression of vertebral canal, and be beneficial to the correction of kyphosis and the recovery of nerve function. It can maintain the long-term stability of internal fixation and the height of fracture vertebral body under osteoporosis condition, and significantly reduce the risk of long-term screw loosening and vertebral collapse.
【作者单位】：成都军区总医院骨科;成都军区总医院麻醉科;解放军184医院骨科;
【基金】：国家自然科学基金青年基金项目(81301606) 第60批中国博士后科学基金面上二等资助项目(2016M603054) 四川省卫生和计划生育委员会科研课题(16PJ020) 成都军区总医院研究型人才资助项目(42412E33)~~
【分类号】：R687.3;R580

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