背景:为了在椎体骨折的前柱重建中实现良好的骨融合,不仅应评估骨矿物质密度(BMD)和骨代谢标志物,还应评估由于椎体之间的骨桥接而引起的杠杆臂。然而,直到现在,没有设计杠杆臂索引。因此,我们认为,骨性和与相邻椎骨交联的椎体的最大数量(maxVB)可用作杠杆臂的量度.目的探讨脊柱骨折前柱重建术的手术效果,以maxVB作为杠杆臂长度的指标,确定椎体间的骨桥接对骨融合率的影响。
方法:回顾性分析2014-2022年81例脊柱骨折前柱重建术患者的临床资料。骨融合率,背痛评分,在maxVB=0和maxVB≥2患者之间进行混杂因素调整(年龄,吸烟史,糖尿病史,BMD,骨质疏松症药物,外科技术,固定椎骨的数量,用于前部道具的材料,等。),并用多变量或多元回归分析进行分析。比较三组(maxVB=0,2≤maxVB≤8,maxVB≥9)的骨愈合率和术后背痛发生率,并在调整混杂因素后除以maxVB。
结果:maxVB≥2的患者骨融合率(p<0.01)和术后背痛评分(p<0.01)明显高于maxVB=0的患者。在三组中,2≤maxVB≤8组的骨融合率和背痛评分明显高于对照组(p=0.01,p<0.01)。
结论:检查maxVB作为使用杠杆臂的指标对于椎体骨折的前柱重建是有益的。没有椎间骨桥或大量骨桥的患者比具有中等数量骨桥的患者更需要促进骨融合的措施。
BACKGROUND: To achieve good bone fusion in anterior column reconstruction for vertebral fractures, not only bone mineral density (BMD) and bone metabolism markers but also lever arms due to bone bridging between vertebral bodies should be evaluated. However, until now, no lever arm index has been devised. Therefore, we believe that the maximum number of vertebral bodies that are bony and cross-linked with the contiguous adjacent vertebrae (maxVB) can be used as a measure for lever arms. The purpose of this study is to investigate the surgical outcomes of anterior column reconstruction for spinal fractures and to determine the effect of bone bridging between vertebral bodies on the rate of bone fusion using the maxVB as an indicator of the length of the lever arm.
METHODS: The clinical data of 81 patients who underwent anterior column reconstruction for spinal fracture between 2014 and 2022 were evaluated. The bone fusion rate, back pain score, between the maxVB = 0 and the maxVB ≥ 2 patients were adjusted for confounding factors (age, smoking history, diabetes mellitus history, BMD, osteoporosis drugs, surgical technique, number of fixed vertebrae, materials used for the anterior props, etc.) and analysed with multivariate or multiple regression analyses. The bone healing rate and incidence of postoperative back pain were compared among the three groups (maxVB = 0, 2≦maxVB≦8, maxVB ≧ 9) and divided by the maxVB after adjusting for confounding factors.
RESULTS: Patients with a maxVB ≥ 2 had a significantly higher bone fusion rate (p < 0.01) and postoperative back pain score (p < 0.01) than those with a maxVB = 0. Among the three groups, the bone fusion rate and back pain score were significantly higher in the 2≦maxVB≦8 group (p = 0.01, p < 0.01).
CONCLUSIONS: Examination of the maxVB as an indicator of the use of a lever arm is beneficial for anterior column reconstruction for vertebral fractures. Patients with no intervertebral bone bridging or a high number of bone bridges are in more need of measures to promote bone fusion than patients with a moderate number of bone bridges are.