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目的探讨可膨胀型椎弓根螺钉联合椎弓根通道植骨治疗伴骨质疏松症的胸腰椎爆裂性骨折的临床效果。方法回顾性分析2010年8月至2014年2月濮阳市中医院收治的23例(23个椎体)伴骨质疏松症的胸腰椎爆裂性骨折患者的临床资料,均采用可膨胀型椎弓根螺钉联合椎弓根通道自体髂后上棘松质骨植骨治疗。统计手术时间、术中失血量和螺钉植入椎弓根位置优良率;比较手术前后伤椎前缘高度比、矢状面Cobb角度变化,观察内固定失败、后凸畸形再发情况。结果手术时间95~156 min,平均手术时间120 min;术中失血量415~706 m L,平均失血量520 m L。23例患者均获得有效随访,随访时间10~22个月(平均18个月)。椎弓根螺钉均膨胀良好,植入椎弓根位置优良率为87%。术前、术后7 d及术后6个月,伤椎前缘高度比和矢状面Cobb角分别为54±7、89±4、86±4和(26.7±2.9)°、(5.7±0.9)°、(6.5±1.7)°,手术前后比较,差异有统计学意义(F=334.520,814.960;P=0.000,0.000)。术后6个月脊髓神经功能Frankel分级(D级2例、E级21例)较术前(C级10例、D级11例、E级2例)明显改善(χ2=31.926,P=0.000)。随访期间患者未有手术相关感染,椎弓根螺钉松动、断裂、拔出及后凸畸形并发症。结论可膨胀型椎弓根螺钉联合椎弓根通道自体松质骨植骨具有复位满意、固定可靠、脊髓神经功能恢复良好等优点,是治疗伴有骨质疏松症的胸腰椎爆裂性骨折的有效方法之一。
Objective To investigate the clinical effect of expandable pedicle screw fixation combined with pedicle screw graft in the treatment of thoracolumbar burst fracture with osteoporosis. Methods The clinical data of 23 patients (23 vertebral bodies) with thoracolumbar burst fractures treated with osteoporosis admitted from Puyang Hospital of Traditional Chinese Medicine from August 2010 to February 2014 were retrospectively analyzed. Treatment of autologous posterior superior iliac spine bone graft with root screw and pedicle screw. The operation time, intraoperative blood loss and the rate of pedicle screw placement were compared. The ratio of anterior and posterior vertebral height and sagittal Cobb angle before and after operation were compared. The failure of internal fixation and recurrence of kyphosis were observed. Results The operation time was 95-156 min with an average operation time of 120 min. The intraoperative blood loss was 415-706 m L and the mean blood loss was 520 m L. All 23 patients were effectively followed up for 10-22 months (mean 18 months). Pedicle screws were well expanded, the good rate of pedicle placement 87%. Preoperative, postoperative 7 and postoperative 6 months, the Cobb angle of the anterior vertebral body and the sagittal plane were 54 ± 7, 89 ± 4, 86 ± 4 and 26.7 ± 2.9 °, respectively, (5.7 ± 0.9) °, (6.5 ± 1.7) °, before and after surgery, the difference was statistically significant (F = 334.520,814.960; P = 0.000,0.000). The Frankel grading (2 cases at D level and 21 cases at E level) of spinal cord neurological function at 6 months after operation was significantly improved (χ2 = 31.926, P = 0.000) compared with that before operation (10 cases in stage C, 11 cases in stage D and 2 cases in stage E) ). During the follow-up, there was no operative infection, pedicle screw loosening, rupture, pull-out and kyphosis complications. Conclusion The expansible pedicle screw combined with autologous cancellous bone graft with pedicle screwway has the advantages of satisfactory reduction, reliable fixation and good recovery of spinal cord nerve function, which is effective in treating thoracolumbar burst fractures associated with osteoporosis One of the ways.