| ObjectiveTo investigate the long-term effect of vertebroplasty combined with pedicle screw-cement in the treatment of severe compressive fracture of thoracolumbar vertebra MethodsRetrospective study analysis: a total of 49 cases of osteoporosis thoracolumbar weight-grade compression fractures admitted to our hospital from January 2008 to December 2013 were collected for medium and long-term follow-up.According to different surgical methods,the patients were divided into three groups.In the control group,15 cases were treated with vertebroplasty combined with pedicle screw internal fixation(group B).The other group included 17 cases of vertebroplasty combined with pedicle screw and cement fixation(group C).According to VAS score,vertebral anterior and posterior margin height,vertebral compression ratio,thoracolumbar kyphoid Cobb Angle,operation time,intraoperative blood loss,hospitalization time,complications and other relevant indicators,the above data were collected and compared between and within groups.Results1.There were statistically significant differences between groups A and B,and between groups A and C in operation time,intraoperative blood loss and hospital stay(P<0.05);There was no significant difference between group B and group C in operation time,intraoperative blood loss and hospital stay(P>0.05).The difference of bone cement usage in the three groups was statistically significant(P<0.05).There was no significant difference in follow-up time and age among the three groups(P>0.05).2.There were statistically significant differences between group A,group B,and group C in anterior vertebral height postoperatively and in the final follow-up(P<0.05),but no statistically significant differences between group B and group C in anterior vertebral height postoperatively(P>0.05),and statistically significant differences in the final follow-up(P<0.05).There were statistically significant differences between group A,group B,and group C in the vertebral compression ratio immediately after surgery and in the final follow-up(P<0.05).There were no statistically significant differences between group B and group C in the vertebral compression ratio immediately after surgery(P>0.05),and there were statistically significant differences between group B and group C in the vertebral compression ratio immediately after surgery(P<0.05).There was no statistically significant difference between preoperative and postoperative Cobb Angle in the thoracolumbar segment in group A(P>0.05),and kyphosis was aggravated in the last follow-up(P<0.05).Immediate postoperative improvement of the thoracolumbar Cobb Angle in group B was compared with that before surgery(P<0.05),but the ratio between the last follow-up and the immediate postoperative was further increased(P<0.05).The median and long-term follow-up of the Cobb Angle in the thoracolumbar segment in group C immediately after surgery and the last follow-up were better than those in group A and group B(P<0.05),with no significant changes.3.There was no difference in VAS score between the three groups before surgery(p>0.05).On the day of discharge,group A was lower than group B and C(P<0.05).There were statistically significant differences among the three groups in the final follow-up(P<0.05),and the score of group C in the final follow-up was better than that of group A and group B(P<0.05).Immediate postoperative X-ray showed that the bone cement leakage rate of group A was 76.5%,that of group B was 26.7%,that of group C was 26.4%,and that the bone cement leakage rate of group B and C was lower than that of group A.During postoperative follow-up,4 cases of pedicle screw loosening and displacement occurred in group B,and 1 case of internal fixation fracture,loosening,recurrence or new vertebral compression fracture occurred in group C.During postoperative follow-up,5 cases of new or recurrent vertebral fractures occurred in group A,with an incidence of 29.4%,while no new vertebral fractures occurred in group B and C.ConclusionVertebral body bone forming joint pedicle screws masonry nail reinforcement treatment of osteoporotic severe compression fractures is safe,reliable and feasible,and can achieve immediate stability,can reduce bone cement leakage rate,reduce the recurrence rate of fractures,by restoring vertebral bodies wounded vertebral height to vertebral vertebral plasty the advantage of simple operation,in the long-term in patients with severe osteoporosis can continue to maintain the stability of the spine,maintain vertebral body height,avoid protrusion deformity after aggravating,and reduce the rate of screw loosening and fracture vertebral body collapse again. |
PDF Full Text Request