| 伤椎单侧置钉结合骨水泥强化与伤椎双侧置钉治疗骨质疏松性胸腰椎骨折的疗效比较 |
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投稿时间：2024-04-17
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| 作者 | Author | 单位 | Address | E-Mail |
| 楼宇梁 |
LOU Yu-liang |
杭州市萧山区中医院骨科, 浙江 杭州 311201 |
Department of Orthopaedics Surgery, Traditional Chinese Medical Hospital of Xiaoshan, Hangzhou 311201, Zhejiang, China |
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| 陈国英 |
CHEN Guo-ying |
杭州市萧山区中医院骨科, 浙江 杭州 311201 |
Department of Orthopaedics Surgery, Traditional Chinese Medical Hospital of Xiaoshan, Hangzhou 311201, Zhejiang, China |
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| 王灿锋 |
WANG Can-feng |
杭州市萧山区中医院骨科, 浙江 杭州 311201 |
Department of Orthopaedics Surgery, Traditional Chinese Medical Hospital of Xiaoshan, Hangzhou 311201, Zhejiang, China |
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| 费慧 |
FEI Hui |
杭州市萧山区中医院骨科, 浙江 杭州 311201 |
Department of Orthopaedics Surgery, Traditional Chinese Medical Hospital of Xiaoshan, Hangzhou 311201, Zhejiang, China |
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| 孙观荣 |
SUN Guan-rong |
杭州市萧山区中医院骨科, 浙江 杭州 311201 |
Department of Orthopaedics Surgery, Traditional Chinese Medical Hospital of Xiaoshan, Hangzhou 311201, Zhejiang, China |
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| 全仁夫 |
QUAN Ren-fu |
杭州市萧山区中医院骨科, 浙江 杭州 311201 |
Department of Orthopaedics Surgery, Traditional Chinese Medical Hospital of Xiaoshan, Hangzhou 311201, Zhejiang, China |
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| 李伟 |
LI Wei |
杭州市萧山区中医院骨科, 浙江 杭州 311201 |
Department of Orthopaedics Surgery, Traditional Chinese Medical Hospital of Xiaoshan, Hangzhou 311201, Zhejiang, China |
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| 洪锋 |
HONG Feng |
杭州市萧山区中医院骨科, 浙江 杭州 311201 |
Department of Orthopaedics Surgery, Traditional Chinese Medical Hospital of Xiaoshan, Hangzhou 311201, Zhejiang, China |
hongf@163.com |
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| 期刊信息：《中国骨伤》2025年，第38卷，第2期，第134-140页 |
| DOI：10.12200/j.issn.1003-0034.20230937 |
| 基金项目: |
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中文摘要:
目的: 探讨经皮椎弓根螺钉联合伤椎单侧置钉结合骨水泥强化与联合伤椎双侧置钉治疗骨质疏松性胸腰椎骨折的疗效。
方法: 回顾性分析2017年10月至2019年5月收治的78例骨质疏松性胸腰椎骨折患者临床资料,根据手术方法分为经皮椎弓根螺钉联合伤椎单侧置钉结合单侧骨水泥强化组(骨水泥组)和经皮椎弓根螺钉联合伤椎双侧置钉(螺钉组)。骨水泥组40例,男16例,女24例,年龄(62.1±8.1)岁。螺钉组38例,男18例,女20例,年龄(65.1±9.3)年。观察比较两组手术时间、术中出血量、住院时间及术后并发症。比较两组术前,术后3 d、6个月、1年及末次随访时节段后凸畸形Cobb角、伤椎前缘高度比值、中央高度比值及疼痛视觉模拟评分(visual analogue scale,VAS)。
结果: 患者均获随访,时间25~36个月。骨水泥组手术时间(70.1±17.3) min,明显短于螺钉组(78.6±18.2) min,差异有统计学意义(P<0.05)。两组术中失血量、住院时间比较差异均无统计学意义(P>0.05)。骨水泥组VAS术后1年(1.5±0.5)分、末次随访(0.5±0.3)分低于螺钉组术后1年(1.8±0.3)分、末次随访(0.8±0.4)分,差异均有统计学意义(P<0.05)。骨水泥组节段后凸畸形Cobb角、伤椎前缘高度比值、中央高度比值术后1年(6.2±1.2)°、(86.6±3.5)%、(91.1±2.5)%,末次随访(6.4±0.7)°、(85.5±3.3)%、(90.5±6.3)%,均优于螺钉组术后1年(6.8±1.4)°、(83.1±2.4)%、(89.9±3.4)%和末次随访(7.1±1.1)°、(82.6±4.1)%、(87.6±5.9)%,差异均有统计学意义(P<0.05)。骨水泥组出现3例骨水泥渗漏,均无临床症状;螺钉组出现2例椎弓根螺钉拔出,末次随访时予拆除螺钉。
结论: 经皮椎弓根螺钉联合伤椎单侧置钉结合骨水泥强化与联合伤椎双侧置钉治疗老年骨质疏松性胸腰椎压缩骨折均可达到满意疗效,可有效缓解患者疼痛,但前者内固定系统更稳定,长期随访时能有效维持伤椎前中柱高度和伤椎后凸畸形矫正的效果,慢性腰背痛发生率更低。 |
| 【关键词】骨质疏松性骨折 胸椎 腰椎 脊柱骨折 手术治疗 |
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| Comparison of the efficacy of unilateral nailing combined with bone cement reinforcement and bilateral nailing in the treatment of osteoporotic thoracolumbar fractures |
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ABSTRACT
Objective To compare the efficacy of percutaneous pedicle screw combined with unilateral nail placement combined with bone cement strengthening and bilateral nail placement in the treatment of osteoporotic thoracic and lumbar fractures.
Methods A retrospective case-control study was used to analyze the clinical data of 78 patients with osteoporotic thoracic and lumbar fractures admitted from October 2017 to May 2019. According to the surgical method,it was divided into percutaneous pedicle screw combined with unilateral nail placement combined with unilateral bone cement strengthening group(bone cement group) and percutaneous pedicle screw combined with bilateral nail placement(screw group). In the bone cement group,40 patients included 16 males and 24 females,with a mean age of (62.1±8.1) years old. In the screw group,38 patients included 18 males and 20 females with a mean age of (65.1±9.3) years old. The operation time,intraoperative blood loss,length of hospital stay and postoperative complications were compared between two groups. The kyphosis Cobb angle,anterior edge height ratio,central height ratio and pain visual analogue score(VAS) were compared.
Results All patients were followed up for 25 to 36 months. The operation time (70.1±17.3) min of the cement group was shorter than that of the screw group (78.6±18.2) min(P<0.05). There were no significant differences in intraoperative blood loss and length of hospital stay(P>0.05). The VAS in the cement group 1 year 1.5±0.5 and the latest follow-up 0.5±0.3 after operation were lower than 1 year 1.8±0.3 and the latest follow-up 0.8±0.4 in the screw group(P<0.05). The kyphosis Cobb angle,anterior edge height ratio,central height ratio in bone cement group,1 year (6.2±1.2)°,(86.6±3.5)%,(91.1±2.5)%,the last follow-up (6.4±0.7)°,(85.5±3.3)%,(90.5±6.3)% were better than that of the screw group 1 year (6.8±1.4)°,(83.1±2.4)%,(89.9±3.4)% and the latest follow-up (7.1±1.1)°,(82.6±4.1)%,(87.6±5.9)%(P<0.05). There were 3 cases of bone cement leakage in the cement group,all of which had no clinical symptoms;and 2 cases of pedicle screws were extracted in the screw group,and the screws were removed at the last follow-up.
Conclusion Percutaneous pedicle screw combined with unilateral nail placement combined with bone cement strengthening and bilateral nail placement in the treatment of osteoporotic thoracic and lumbar compression fractures in the elderly can achieve satisfactory efficacy and effectively relieve the pain of patients,but the former internal fixation system is more stable,and the long-term follow-up can effectively maintain the height of the anterior middle column and the correction of kyphosis deformity,and the incidence of chronic low back pain is lower. |
| KEY WORDS Osteoporotic fractures Thoracic vertebra Lumbar vertebrae Spine fractures Surgical treatment |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 楼宇梁,陈国英,王灿锋,费慧,孙观荣,全仁夫,李伟,洪锋.伤椎单侧置钉结合骨水泥强化与伤椎双侧置钉治疗骨质疏松性胸腰椎骨折的疗效比较[J].中国骨伤,2025,38(2):134~140 |
| 英文格式: | LOU Yu-liang,CHEN Guo-ying,WANG Can-feng,FEI Hui,SUN Guan-rong,QUAN Ren-fu,LI Wei,HONG Feng.Comparison of the efficacy of unilateral nailing combined with bone cement reinforcement and bilateral nailing in the treatment of osteoporotic thoracolumbar fractures[J].zhongguo gu shang / China J Orthop Trauma ,2025,38(2):134~140 |
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