损伤椎体植骨联合椎弓根钉棒系统配合药物治疗老年腰椎压缩性骨折的疗效观察

中华创伤杂志 Pub Date : 2020-01-15 DOI:10.3760/CMA.J.ISSN.1001-8050.2020.01.007

Wu Zhou, T. Xia, Faqi Cao, Jing Liu, Liangcong Hu, Mengfei Liu, Qisheng Zhou, Guohui Liu

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There were 28 cases in non-bone grafting group involving 19 males and nine females, aged from 60 to 75 years [(62.4±2.9)years]. The Frankel scale in bone grafting group was grade D in 15 cases and grade E in 5, and in non-bone grafting group was grade D in 18 cases and grade E in 10. All the cases were treated by pedicle screw fixation combined with antiosteoporosis drugs, and the bone grafting group were treated by bone grafting via the injured vertebrae, but the other group were not. The intraoperative blood loss and operation time for each segmental vertebrae were recorded. The visual analogue scale (VAS) before operation and one year after operation, the bone healing at three months and one year postoperatively were recorded. The compression rate of the injured vertebrae at operation, at one day and one-year postoperatively as well as the height loss of the injured vertebrae at postoperative one year were measured. Spinal cord injury was also evaluated by Frankel scale. Wound healing, lower limb thrombosis, lung infection and ulcer were observed. \n \n \nResults \nAll the cases were followed up, with duration for 12-25 months [(16.2±3.4)months] in bone grafting group and 15-24 months [(17.5±5.4)months] in non-bone grafting group (P>0.05). The blood loss was (240±70)ml in bone grafting group and (210±65)ml in non-bone grafting group (P>0.05). Screw implantation time for each segment was (38.5±9.6)minutes in bone grafting group and (30.5±5.4)minutes in non-bone grafting group (P 0.05). No significant difference was found in compression rate of the injured vertebral height between the two groups before and after operation (P>0.05). 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引用次数: 0

摘要

目的探讨损伤椎体植骨联合椎弓根钉棒系统配合药物治疗老年腰椎压缩性骨折的临床效果。方法采用回顾性病例对照研究，分析2015年10月至2018年10月我院收治的48例老年腰椎压缩性骨折的临床资料。男性34例，女性14例，年龄60 ~ 78岁[(62.8±2.5)岁]。L1损伤37例，L2损伤7例，L3损伤2例，L4损伤4例。植骨组20例，男15例，女5例，年龄60 ~ 78岁[(63.7±2.1)岁]。非植骨组28例，男19例，女9例，年龄60 ~ 75岁[(62.4±2.9)岁]。植骨组Frankel评分为D级15例，E级5例;非植骨组为D级18例，E级10例。所有病例均采用椎弓根螺钉固定联合抗骨质疏松药物治疗，植骨组采用经伤椎体植骨治疗，另一组不采用。记录各节段椎骨术中出血量及手术时间。记录术前、术后1年视觉模拟评分(VAS)，术后3个月、1年骨愈合情况。测量术中、术后1天、1年损伤椎体的压缩率以及术后1年损伤椎体的高度损失。采用Frankel评分法评价脊髓损伤程度。观察创面愈合、下肢血栓形成、肺部感染及溃疡情况。结果所有病例均获得随访，植骨组随访12 ~ 25个月[(16.2±3.4)个月]，非植骨组随访15 ~ 24个月[(17.5±5.4)个月](P < 0.05)。植骨组出血量为(240±70)ml，非植骨组出血量为(210±65)ml (P < 0.05)。植骨组各节段螺钉植入时间为(38.5±9.6)min，非植骨组为(30.5±5.4)min (P < 0.05)。两组手术前后损伤椎体高度压缩率差异无统计学意义(P < 0.05)。术后1年，植骨组损伤椎体高度损失率为3%(2%，4%)，非植骨组为6%(5%，8%)，差异有统计学意义(P < 0.05)。结论对于老年腰椎压缩性骨折，椎体植骨联合椎弓根钉棒系统配合药物治疗，虽然延长了植骨时间，但在恢复和维持损伤椎体高度、缓解疼痛和促进骨愈合方面明显更好。关键词:腰椎;脊柱骨折;岁的;骨移植

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Efficacy of bone grafting in the injured vertebrae combined with pedicle screw-rod system assisted with drugs in treating lumbar vertebral compression fracture in the elderly

Objective To explore the clinical effect of bone grafting in the injured vertebrae combined with pedicle screw-rod system assisted with drugs in treating lumbar vertebral compression fracture in the elderly. Methods A retrospective case-control study was carried out to analyze the clinical data of 48 cases of lumbar vertebral compression fracture in the elderly admitted to the Union Hospital between October 2015 and October 2018. There were 34 males and 14 females, aged 60-78 years [(62.8±2.5)years]. Segment of injury was L1 in 37 cases, L2 in 7, L3 in 2, and L4 in 4. There were 20 cases in bone grafting group involving 15 males and five females, aged from 60 to 78 years [(63.7±2.1)years]. There were 28 cases in non-bone grafting group involving 19 males and nine females, aged from 60 to 75 years [(62.4±2.9)years]. The Frankel scale in bone grafting group was grade D in 15 cases and grade E in 5, and in non-bone grafting group was grade D in 18 cases and grade E in 10. All the cases were treated by pedicle screw fixation combined with antiosteoporosis drugs, and the bone grafting group were treated by bone grafting via the injured vertebrae, but the other group were not. The intraoperative blood loss and operation time for each segmental vertebrae were recorded. The visual analogue scale (VAS) before operation and one year after operation, the bone healing at three months and one year postoperatively were recorded. The compression rate of the injured vertebrae at operation, at one day and one-year postoperatively as well as the height loss of the injured vertebrae at postoperative one year were measured. Spinal cord injury was also evaluated by Frankel scale. Wound healing, lower limb thrombosis, lung infection and ulcer were observed. Results All the cases were followed up, with duration for 12-25 months [(16.2±3.4)months] in bone grafting group and 15-24 months [(17.5±5.4)months] in non-bone grafting group (P>0.05). The blood loss was (240±70)ml in bone grafting group and (210±65)ml in non-bone grafting group (P>0.05). Screw implantation time for each segment was (38.5±9.6)minutes in bone grafting group and (30.5±5.4)minutes in non-bone grafting group (P 0.05). No significant difference was found in compression rate of the injured vertebral height between the two groups before and after operation (P>0.05). The height loss rate of the injured vertebrae was 3% (2%, 4%) at one year postoperatively in bone grafting group and 6% (5%, 8%) in non-bone grafting group (P 0.05). Conclusion For lumbar vertebral compression fracture in the elderly, bone grafting in the injured vertebrae combined with pedicle screw-rod system assisted with drugs is significantly better in recovering and maintaining the injured vertebrae height, relieving the pain and promoting the bone healing, although the screw implantation time is prolonged. Key words: Lumbar; Spinal fractures; Aged; Bone grafting

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中华创伤杂志

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期刊介绍： Chinese Journal of Trauma (International Standard Serial Publication Number: ISSN 1001-8050, Domestic Uniform Serial Publication Number: CN 50-1098/R) was founded in September 1985, which is the only high-level medical professional academic journal that can comprehensively and systematically reflect the achievements and development trends of China's traumatology medicine, and has a wide academic influence in China's traumatology medicine community. It has a wide range of academic influence in China's trauma medicine. Chinese Journal of Trauma is a source journal of China Science and Technology Paper Statistics, a source journal of China Science Citation Database (CSCD), a core journal of China Comprehensive Medicine and Health Care, a source journal of China Academic Journals Comprehensive Evaluation Database (CAJCED), a full-text journal of China Journal Full-text Database (CJFD), a core academic journal of China Center for Scientific Evaluation (RCCSE), a core academic journal of China Traumatology and Traumatology Center (CTC), a core academic journal of China Traumatology Center (RCCSE). RCCSE) core academic journals; Chinese Biomedical Journal Database (CMCC), Chinese Biomedical Journal Citation Database (CBJCED), China Journal Network (CJN), China Academic Journals (CD-ROM), Chinese Academic Journals Abstracts (Chinese Edition), Chemical Abstracts of the United States (CA), Index Copernicus of Poland (IC), and Japan Institute of Science and Technology Database (JICST), World Health Organization Western Pacific Region Medical Search (WPRIM) and Russian Journal of Abstracts (ΡЖ) included journals.