CAJ | 학술논문

背景：椎体成形术与椎弓根螺钉内固定都是胸腰椎骨折的有效修复方案，但胸腰椎压缩性骨折内固定取出后脊柱角度丢失是较为常见的并发症，经皮椎体成形术可能是预防脊柱角度丢失的较好选择。 　　目的：观察骨水泥强化椎弓根螺钉置入内固定修复L1压缩性骨折的临床疗效及并发症，并与单纯椎弓根螺钉内固定比较。 　　方法：纳入L1压缩性骨折患者76例，根据内固定修复方案分为两组，经皮椎体成形组40例行骨水泥联合椎弓根螺钉置入内固定治疗，单纯椎弓根内固定组36例仅行椎弓根螺钉置入内固定治疗。比较两组的修复效果，置入后即刻、置入后3，6个月以伤椎为中心进行MRI检查测量Cobb角、伤椎椎体前缘高度，同时记录目测类比评分；另外了解有无内固定松动断裂。 　　结果与结论：两组患者随访6个月内均获骨性愈合，无螺钉松动、折断。两组置入后6个月损伤节段后凸Cobb角、伤椎椎体前缘高度均较置入前明显改善(P<0.01)，椎体成形组要优于单纯椎弓根内固定组(P<0.05)。两组置入后6个月目测类比评分较置入前明显改善(P<0.01)，但两组差异无显著性意义(P>0.05)。表明应用骨水泥强化椎弓根螺钉内固定及椎弓根钉内固定修复L1压缩性均可获得满意复位，重建椎体高度。但抗压稳定性结果表明应用骨水泥强化椎弓根螺钉内固定的固定效果更好一些，未见短期断钉、矫正丢失等并发症，椎体骨水泥灌注可提高椎弓根螺钉置入后的稳定性。
배경：추체성형술여추궁근라정내고정도시흉요추골절적유효수복방안，단흉요추압축성골절내고정취출후척주각도주실시교위상견적병발증，경피추체성형술가능시예방척주각도주실적교호선택。 　　목적：관찰골수니강화추궁근라정치입내고정수복L1압축성골절적림상료효급병발증，병여단순추궁근라정내고정비교。 　　방법：납입L1압축성골절환자76례，근거내고정수복방안분위량조，경피추체성형조40례행골수니연합추궁근라정치입내고정치료，단순추궁근내고정조36례부행추궁근라정치입내고정치료。비교량조적수복효과，치입후즉각、치입후3，6개월이상추위중심진행MRI검사측량Cobb각、상추추체전연고도，동시기록목측류비평분；령외료해유무내고정송동단렬。 　　결과여결론：량조환자수방6개월내균획골성유합，무라정송동、절단。량조치입후6개월손상절단후철Cobb각、상추추체전연고도균교치입전명현개선(P<0.01)，추체성형조요우우단순추궁근내고정조(P<0.05)。량조치입후6개월목측류비평분교치입전명현개선(P<0.01)，단량조차이무현저성의의(P>0.05)。표명응용골수니강화추궁근라정내고정급추궁근정내고정수복L1압축성균가획득만의복위，중건추체고도。단항압은정성결과표명응용골수니강화추궁근라정내고정적고정효과경호일사，미견단기단정、교정주실등병발증，추체골수니관주가제고추궁근라정치입후적은정성。
BACKGROUND:Vertebroplasty and edicle screw fixation are effective repair methods for thoracolumbar fractures. Spine angle loss is a more common complication after removal of implant for thoracolumbar compression fractures. Percutaneous vertebroplasty may be a better choice for preventing spine angle loss. OBJECTIVE:To investigate the clinical curative effect and complication of pedicle screw fixation with bone cement for repair of L1 compression fractures, and to compare with pedicle screw fixation alone. METHODS: A total of 76 cases of L1 compression fractures were enroled and assigned to two groups according to fixation repair method. 40 patients in the vertebroplasty group received bone cement and pedicle screw fixation. 36 patients in the pedicle screw fixation group received pedicle screw fixation alone. Repair effects were compared between the two groups. MRI examination was conducted immediately, 3 and 6 months after surgery taking injured vertebral body as a center to measure Cobb angle and the height of anterior border of the injured vertebral body. Simultaneously, visual analogue scale score was recorded. Loosing and breakage of the fixator were seen. RESULTS AND CONCLUSION:Bone union was detected within 6 months of folow-up in the two groups, no screw loosing or breakage. Kyphosis Cobb angle and the height of anterior border of the vertebral body were significantly improved at 6 months after surgery in both groups (P < 0.01). Above indexes were better in the vertebroplasty group than in the pedicle screw fixation group (P < 0.05). Visual analogue scale score was significantly improved at 6 months post surgery in both groups (P< 0.01), but no significant difference was found between the two groups (P > 0.05). These findings suggested that pedicle screw fixation with bone cement and pedicle screw fixation alone for L1 compression fracture obtained satisfactory reduction, and reconstructed the height of the vertebral body. However, results of compressive stability indicated that the fixation effect of pedicle screw fixation with bone cement was better than that of pedicle screw fixation alone. No short-term screw breakage and correction loss occurred. Perfusion with bone cement could elevate the stability of pedicle screw implantation.