经皮椎体成形、经皮椎体后凸成形及膨胀式椎弓根钉置入内固定修复原发性骨质疏松性胸腰椎骨折

发布时间：2018-02-22 13:52

本文关键词： 骨质疏松脊柱骨折椎体成形术组织工程骨科植入物脊柱植入物椎体骨折膨胀式椎弓根螺钉经皮椎体成形术经皮椎体后凸成形术　出处：《中国组织工程研究》2017年03期 　论文类型：期刊论文

【摘要】：背景:经皮椎体成形、经皮椎体后凸成形和膨胀式椎弓根螺钉内固定均可修复原发性骨质疏松性胸腰椎骨折,这3种方法各有其优缺点。目的:探讨原发性骨质疏松性胸腰椎骨折的修复方式及效果。方法:纳入61例诊断为原发性骨质疏松性胸腰椎骨折的患者,入院后积极做好围手术期的治疗和处理,分别采取经皮椎体成形、经皮椎体后凸成形和膨胀式椎弓根螺钉置入内固定治疗,记录所有患者术前、术后3个月的疼痛目测类比评分和Oswestry功能障碍指数(ODI),以及术前、术后3 d及术后3个月伤椎的矢状面指数和Cobb角等指标并进行统计分析。结果与结论:(1)所有患者术后均获得随访,随访时间12-18个月;(2)3组患者术前的疼痛目测类比评分、ODI、伤椎的矢状面指数及Cobb角比较差异无显著性意义(P0.05);(3)3组术后3个月的疼痛目测类比评分、ODI均较术前降低,差异有显著性意义(P0 05),组间比较疼痛目测类比评分、ODI差异无显著性意义(P0.05);(4)3组术后3 d、术后3个月伤椎的矢状面指数、Cobb角均较术前增大,差异有显著性意义(P0 05),组间比较差异有显著性意义(P0 05),经皮椎体后凸成形组与膨胀式椎弓根螺钉内固定组效果类似(P0.05),且优于经皮椎体成形组(P0.05);(5)结果说明,3种修复方式均能有效恢复椎体高度和强度,缓解疼痛,稳定脊柱,术后短期内椎体无明显的压缩;但在术后椎体高度的恢复程度方面,经皮椎体后凸成形、膨胀式椎弓根螺钉内固定优于经皮椎体成形。另外,3种修复方案均有各自的适应证、优缺点,正确选择修复方式是提高修复效果的关键。
[Abstract]:Background: percutaneous vertebroplasty, percutaneous kyphoplasty and internal fixation with expanded pedicle screw can be used to repair primary osteoporotic thoracolumbar fractures. Objective: to investigate the repair methods and effects of primary osteoporotic thoracolumbar fractures. Methods: 61 patients with primary osteoporotic thoracolumbar fractures were included. The patients were treated with percutaneous vertebroplasty, percutaneous vertebral kyphoplasty and internal fixation with expansion pedicle screw. All the patients were recorded before operation. The pain visual analogies score and Oswestry dysfunction index were evaluated 3 months after operation and before operation. Sagittal index and Cobb angle of injured vertebrae were analyzed 3 days after operation and 3 months after operation. Results and conclusion all patients were followed up after operation. The postoperative pain visual analogue score (ODI), sagittal index (SMI) and Cobb angle of the injured vertebrae were not significantly different in the follow-up period of 12 to 18 months after operation in the 3 groups (P 0.05) and the visual analogue scores of pain in the 3 groups were lower than those before operation. The difference was significant (P 0.05). There was no significant difference in visual analogue scores of pain and ODI between the groups. The sagittal index and Cobb angle of the injured vertebrae were increased 3 days after operation in the 3 groups, and the Cobb angle of the injured vertebrae was increased 3 months after operation. There was a significant difference between the two groups (P 0.05). The effect of percutaneous kyphoplasty group and expansion pedicle screw fixation group was similar to that of the expansion pedicle screw fixation group, and better than that of the percutaneous vertebroplasty group. All the methods can effectively restore the height and strength of the vertebrae. Relief of pain, stabilization of the spine, no obvious compression of the vertebral body in a short period of time after the operation, but in terms of the degree of recovery of the height of the vertebral body after the operation, the percutaneous vertebrae kyphosis, Expansion pedicle screw internal fixation is superior to percutaneous vertebroplasty. In addition, all three repair schemes have their own indications, advantages and disadvantages, the correct selection of repair methods is the key to improve the repair effect.
【作者单位】：重庆市中医院骨二科;成都体育学院附属医院;
【分类号】：R687.3;R580

【参考文献】