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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:

期数:

2021年01期

页码:

27-33

栏目:

脊柱

出版日期:

2021-02-05

文章信息/Info

Title:

Effect of vertebroplasty combined with pedicle screw internal fixation on functional recovery of patients with thoracolumbar fractures of the spine

作者:

李忠辉1; 于涛2; 张晓艳3

236600 安徽中医药大学附属太和县中医医院骨科1；157000 牡丹江医学院附属第二医院骨外科2；236600 安徽中医药大学附属太和县中医医院急诊科3

Author(s):

Li Zhonghui1, Yu Tao2, Zhang Xiaoyan3

关键词:

椎体成形术;  椎弓根螺钉内固定;  脊柱;  功能恢复

Keywords:

Vertebroplasty;  Pedicle screw internal fixation;  Spine;  Recovery of function

DOI:

10.3877/cma.j.issn.2096-0263.2021.01.006

文献标志码:

A

摘要:

目的 探究椎体成形术联合椎弓根螺钉内固定对脊柱胸腰段骨折患者功能恢复的影响。方法 前瞻性收集安徽中医药大学附属太和县中医医院2016年1月至2018年12月收治的脊柱胸腰段骨折患者96例，使用随机数字表法将其分为单一组（48例）及联合组（48例），单一组使用椎弓根螺钉内固定术进行治疗，联合组在其基础上加用椎体成形术。观察比较两组患者手术前后伤椎恢复情况、疼痛、功能障碍指数，检测并比较两组手术前后血清神经功能相关指标并记录两组术后不良事件发生率。结果 96例患者全部获得随访，随访时间（4.43±1.21）月。男51例，女45例，平均年龄（75.24±5.39）岁。术后3 d，两组伤椎恢复情况差异无统计学意义，术后3个月联合组前缘压缩率（39±4）%、椎管狭窄率（30±4）%、Cobb角（11.1±2.2）°低于单一组[（41±4）%、（32±4）%、（12.2±2.4）°，t=2.085，2.103，2.341，P＜0.05）]；术后3 d，两组视觉模拟评分法（VAS）、Oswestry功能障碍指数问卷表（ODI）评分差异无统计学意义（P＞0.05），术后3个月，联合组VAS[（4.5±0.5）分]、ODI[（58±6）分]低于单一组[（5.9±0.6）分，（65±6）分，t=12.978，5.236，P＜0.05]；术后3 d，两组神经元特异性烯醇化酶（NSE）、脑源性神经营养因子（BDNF）、S100β及神经生长因子（NGF）水平差异无统计学意义（P＞0.05），术后3个月，联合组BDNF水平[（34.27±6.85）ng/ml]高于单一组[（30.95±6.19）ng/ml]，NSE[（12.08±1.41）ug/l]、S100β[（0.17±0.03）ng/ml]及NGF水平[（97.69±9.77）ng/ml]低于单一组[（14.62±2.92）ug/l，（0.24±0.05）ng/ml，（104.26±10.43）ng/ml，t=2.491，4.648，8.317，3.185，P＜0.05]；联合组不良事件发生率低于单一组（c2=5.790，P＜0.05）。结论 椎体成形术联合椎弓根螺钉内固定治疗脊柱胸腰段骨折能有效改善患者术后椎体结构恢复，减轻患者术后疼痛及功能障碍，改善患者术后神经功能，降低不良事件发生率，椎弓根螺钉固定联合椎体成形术治疗老年胸腰段骨折的初步疗效优于单纯椎弓根螺钉固定。

Abstract:

Objective To investigate the effect of vertebroplasty combined with pedicle screw fixation on functional recovery in patients with thoracolumbar fracture. Methods A total of 96 patients with thoracolumbar spine fractures admitted to our hospital from January 2016 to December 2018 were selected and randomly divided into a single group (48 cases) and a combined group (48 cases). The single group was treated with pedicle screw fixation, while the combined group was treated with vertebra plasty. The recovery, pain and dysfunction indexes of the injured vertebrae in the two groups before and after surgery were observed and compared. The indexes related to serum nerve function in the two groups before and after surgery were detected and compared, and the incidence of postoperative adverse events in the two groups were recorded. Results Three days after surgery, there was no significant difference in the recovery of injured vertebrae between the two groups (P>0.05). On postoperative 3 d, there was no significant difference in Visual Analogue Scale/Score (VAS) and Oswestry Dability Index (ODI) scores between the two groups (P>0.05). Three months after surgery, VAS and ODI scores of the combined group were significantly lower than those of the single group (P<0.05). On postoperative day 3, there was no significant difference in the levels of neuron specific enolase (NSE), brain derived neurotrophic factor (BDNF), S100 and Nerve growth factor (NGF) between the two groups (P>0.05). NSE, S100 beta and NGF levels were significantly lower in the single group (P<0.05). The incidence of adverse events in the combined group was significantly lower than that in the single group (P<0.05). Conclusion vertebroplasty combined with pedicle screw internal fixation to thoracolumbar fracture of spine can effectively improve the recovery of vertebral body after surgery, reduce postoperative pain and dysfunction, improve postoperative neurological function, and reduce the incidence of adverse events.

备注/Memo

备注/Memo:

基金项目： 2016年省卫生计生青年科研课题资助计划（2016-1-100）

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更新日期/Last Update: 2021-03-26