短节段与长节段椎弓根螺钉治疗骨质疏松性腰椎骨折的疗效分析

目的对比观察中老年骨质疏松性腰椎骨折患者应用短节段与长节段椎弓根螺钉治疗的临床效果。方法回顾性分析我院2012年7月~2015年5月收治的中老年骨质疏松性腰椎骨折患者56例的临床治疗资料,其中男性20例,女性36例;年龄55~70岁(平均62.7岁)。按照治疗方式不同,分为后路短节段椎弓根螺钉组(26例)和后路长节段椎弓根螺钉组(30例)。观察两组患者的手术时间、术中出血量、术后3个月、18个月伤椎前缘压缩变化和术后3个月、18个月Cobb角变化情况。结果术后随访12~24月,平均18月。所有患者术后随访均未出现感染和内固定失效。手术前两组患者在伤椎前缘压缩和Cobb角变化差异均无显著性差异(0.05)。后路短节段椎弓根螺钉组在手术时间和术中出血量方面比较,均小于长节段椎弓根螺钉组,差异具有显著性意义(0.05);在术后3个月、18个月伤椎前缘压缩和术后Cobb角变化方面比较,差异均无显著性差异(0.05)。结论后路短节段椎弓根螺钉组和后路长节段椎弓根螺钉组修复中老年骨质疏松性腰椎骨折均能够有效恢复椎体前缘高度,能够有效改善椎体后凸畸形,但后路短节段椎弓根螺钉组能有效缩短手术时间和减少术中出血量,中老年骨质疏松患者可优先考虑。

Comparison of short-segment and long-segment pedicle screw fixation for elderly patients with Lumbar fractures

Objective To evaluate the effect of the short-segment pedicle screw and the long-segment pedicle screw fixation for elderly patients in the osteoporotic of Lumbar fractures. Methods 56 cases of Lumbar fractures were treated with the short-segment pedicle screw and the long-segment pedicle screw from July 2012 to May 2015. They were 20 men and 36 women aged from 55 to 70 years (average, 62.7 years). According to the ways of treatment, they were treated with short-segment pedicle screw (26 patients) and long-segment pedicle screw (30 patients). All patients were assessed from time of operation, blood loss, anterior vertebral compression rate and Cobb angle between the two groups after fixation, to evaluate the effect of clinical results and functional recovery. Results The patients were followed up for average 18 months (range, 12 to 24 months). All patients did not have infection, no reduction loss. There was no significant difference in anterior vertebral compression rate and Cobb angle between the two groups before fixation (P>0.05). Compared with long-segment pedicle screw group, patients of short-segment pedicle screw had fewer time of operation, blood loss with significant differences (P<0.05). There was no significant difference in anterior vertebral compression rate and Cobb angle between the two groups after three months of operation (P>0.05). Conclusion The use of short-segment pedicle screw and the long-segment pedicle screw have recovery of anterior vertebral compression and Cobb angle. But the use of short-segment pedicle screw can have short time of operation and less blood loss, so in the treatment of elderly can consider options short-segment pedicle screw fixation.