中国组织工程研究 ›› 2017, Vol. 21 ›› Issue (3): 350-355.doi: 10.3969/j.issn.2095-4344.2017.03.005

• 脊柱植入物 spinal implant • 上一篇    下一篇

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

王 令1,赵红霞1,华 强2   

  1. 1重庆市中医院骨二科,重庆市 400010;2成都体育学院附属医院,四川省成都市 610041
  • 修回日期:2016-12-21 出版日期:2017-01-28 发布日期:2017-03-14
  • 通讯作者: 赵红霞,硕士,主治医师,重庆市中医院骨二科,重庆市 400010
  • 作者简介:王令,男,1981年生,重庆市奉节县人,汉族,2013年泸州医学院毕业,硕士,医师,主要从事创伤骨科研究。

Percutaneous vertebroplasty, percutaneous kyphoplasty and expansive pedicle screw fixation for repairing primary osteoporotic thoracolumbar fractures  

Wang Ling1, Zhao Hong-xia1, Hua Qiang2   

  1. 1Second Department of Orthopedics, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400010, China; 2Affiliated Hospital, Chengdu Sport Institute, Chengdu 610041, Sichuan Province, China
  • Revised:2016-12-21 Online:2017-01-28 Published:2017-03-14
  • Contact: Zhao Hong-xia, Master, Attending physician, Second Department of Orthopedics, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400010, China
  • About author:Wang Ling, Master, Physician, Second Department of Orthopedics, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400010, China

摘要:

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文题释义:
膨胀式椎弓根螺钉:为提高椎弓根螺钉在椎体骨质疏松条件下的稳定性,并结合普通椎弓根螺钉的特点,研究设计出一种新型的椎体内固定器械,命名为膨胀式椎弓根螺钉,其经生物力学试验证实,较同规格普通椎弓根螺钉固定强度可提高30%-50%,可弥补椎体成形术的不足,适用于爆裂性的、压缩高度大于1/2的、椎管占位超过50%,伴或者不伴脊髓神经受损的原发性骨质疏松性椎体骨折患者。
骨折复位:是围手术期重要的一步,无论采取何种手术方式,因患者骨质疏松严重,术中骨折复位不能强求,故术前尽量将骨折予以复位。临床上可采用垫枕疗法,该方法简单、安全、有效。入院后患者平卧于硬板床上,保持脊柱平直,在伤椎下垫一适当高度、宽度的软枕,并根据骨折复位情况进行高度调整。
 
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;②3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(P > 0.05);③3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(P < 0 05),组间比较疼痛目测类比评分、ODI差异无显著性意义(P > 0.05);④3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(P < 0 05),组间比较差异有显著性意义(P < 0 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(P > 0.05),且优于经皮椎体成形组(P < 0.05);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。

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
ORCID:
0000-0001-7908-5454(王令)

关键词: 骨科植入物, 脊柱植入物, 骨质疏松, 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

Abstract:

BACKGROUND: Percutaneous vertebroplasty, percutaneous kyphoplasty and expandable pedicle screw fixation can treat primary osteoporotic thoracolumbar fractures. The three methods have their own advantages and disadvantages. 

OBJECTIVE: To investigate the methods and clinical effects of primary osteoporotic thoracolumbar fractures. 
METHODS: Clinical data of 61 patients with primary osteoporotic thoracolumbar fractures were collected and retrospectively analyzed. Perioperative preparation must be done. All patients were treated by percutaneous vertebroplasty, percutaneous kyphoplasty and expansive pedicle screw fixation. We recorded Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI) before treatment, 3 months after treatment, as well as sagittal index (SI) and Cobb angle of vertebral fracture before treatment, 3 days and 3 months after treatment. 
RESULTS AND CONCLUSION: (1) All cases were followed up for 12-18 months. (2) There was no significant difference in VAS scores, ODI, SI and Cobb angle of vertebral fracture among the three groups of patients preoperatively. (3) At 3 months after treatment, there were significant differences in VAS scores and ODI in the three groups as compared with that preoperation (P < 0.05). However, no significant difference in VAS and ODI was determined among intergroup comparison (P > 0.05). (4) SI and Cobb angle of vertebral fracture were significantly increased; the difference was statistically significant (P < 0.05). The efficacy was similar between the percutaneous kyphoplasty and expansive pedicle screw fixation groups (P > 0.05), and was better than the percutaneous vertebroplasty group (P < 0.05). (5) Three kinds of treatment can effectively restore the vertebral height and intensity, relieve pain and stabilize the spine, and no significant vertebral compression was found in the short term. However, restoration of postoperative vertebral height was better in percutaneous kyphoplasty and expansive pedicle screw fixation groups than in the percutaneous vertebroplasty group. In view of their respective indications, advantages and disadvantages, the key point of raising therapeutic effect was to choose appropriate surgical procedures. 

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程

Key words: Osteoporosis, Spinal Fractures, Vertebroplasty, Tissue Engineering

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