经皮椎弓根螺钉置入内固定结合硫酸钙人工骨治疗单一椎体胸腰椎骨折:3个月随访

发布时间：2018-09-07 19:45

【摘要】：背景:近年来国内外学者将经皮椎弓根螺钉内固定用于修复胸腰椎骨折,取得了良好的临床疗效。可注射硫酸钙的生物兼容性好,在机体中易于吸收降解,而且其固化速度快。目的:探讨经皮椎弓根螺钉内固定结合可硫酸钙骨水泥治疗单一椎体胸腰椎骨折的临床效果。方法:回顾性分析获得完整随访资料的40例单一椎体胸腰椎骨折不伴有神经损伤患者,所有骨折椎体压缩30%,伤椎至少有一侧椎弓根完整。均采用经皮椎弓根螺钉置入内固定结合硫酸钙人工骨治疗。详细记录术前、术后3个月及术后末次随访时患者腰腿痛目测类比评分和ODI;并进行X射线片检查,测量伤椎椎体前缘高度百分比及矢状位脊柱局部后凸Cobb角度;另外记录患者对手术的主观满意度(分为优、良、中、差4级)及术后骨折愈合率。结果与结论:(1)术后3个月、末次随访患者ODI分别为16.3%,4.4%;(2)与术前相比,术后3个月随访时,本组患者的伤椎局部后凸Cobb角及疼痛目测类比评分均减小,伤椎前缘高度百分比增加,差异有显著性意义(P0.01);(3)末次随访患者骨折愈合率为95%,2例患者末次随访时骨折未愈合,患者对手术主观满意度的优良率为95%;(4)与术后3个月比较,末次随访患者胸腰椎局部矢状位Cobb角、伤椎前缘高度均有丢失,但差异无显著性意义(P0.05),与术前相比均显著改善(P0.01);(5)结果表明,在严格掌握手术适应证的前提下,经皮椎弓根螺钉内固定结合硫酸钙治疗单一椎体胸腰椎骨折安全可靠,可恢复伤椎前缘高度,减轻疼痛,远期疗效满意,注入硫酸钙可获得较高的骨折愈合率。
[Abstract]:Background: in recent years, percutaneous pedicle screw fixation has been used to repair thoracolumbar fractures. Injectable calcium sulfate has good biocompatibility, easy absorption and degradation in the body, and its curing speed is fast. Objective: to investigate the clinical effect of percutaneous pedicle screw fixation combined with calcium sulfate cement in the treatment of single vertebral thoracolumbar fracture. Methods: 40 cases of thoracolumbar vertebrae fracture without nerve injury were retrospectively analyzed. The vertebral compression of all fractures was 30, and the pedicle of the injured vertebra was intact at least. All patients were treated with percutaneous pedicle screw fixation and calcium sulfate artificial bone. The analogue score and ODI; of lumbago and leg pain were recorded in detail before operation, 3 months after operation and at the end of follow-up. X-ray examination was performed to measure the percentage of anterior height of injured vertebrae and the Cobb angle of sagittal local kyphosis. The subjective satisfaction (excellent, good, moderate and poor) and the rate of fracture healing were also recorded. Results and conclusion: (1) the ODI of the patients at 3 months and the last follow-up were 16.3and 4.4, respectively. (2) compared with the preoperative follow-up, the Cobb angle of local kyphosis and the visual analogue score of pain were decreased and the percentage of the anterior height of the injured vertebrae increased. The difference was significant (P0.01); (3). The fracture healing rate in the last follow-up was 95%. The excellent and good rate of subjective satisfaction was 95%. (4) compared with 3 months after operation, the rate of fracture healing was 95%. The local sagittal Cobb angle of thoracolumbar vertebrae and the height of anterior edge of injured vertebrae were all lost in the last follow-up, but there was no significant difference (P0.05). The results showed that the operation indication was strictly grasped under the condition that the local sagittal Cobb angle of thoracolumbar vertebrae was improved (P0.01); (5). Percutaneous pedicle screw fixation combined with calcium sulfate in the treatment of single thoracolumbar vertebra fractures is safe and reliable. It can recover the height of the anterior edge of the injured vertebrae and relieve the pain. The long-term curative effect is satisfactory. The high rate of fracture healing can be obtained by injecting calcium sulfate.
【作者单位】：重庆三峡中心医院骨科;
【分类号】：R687.3

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