围绝经期胸腰椎骨折两种伤椎重建术式的疗效对比分析  

Comparative analysis of clinical outcomes between two kinds of operation methods for vertebral reconstruction in treatment of thoracolumbar fracture in postmenopausal patients

作　　者：荚龙[1] 于研[1] 曾至立[1] 吴洋春[1] 程黎明[1] 

机构地区：[1]同济大学附属同济医院脊柱外科,上海200065

出　　处：《中国矫形外科杂志》2015年第6期502-507,共6页Orthopedic Journal of China

基　　金：上海市级医院新兴前沿技术项目(编号:SHDC2013108)

摘　　要：[目的]比较围绝经期胸腰椎骨折两种不同伤椎重建术式（经皮椎体后凸成形术与伤椎置钉联合可注射硫酸钙椎体增强术）的临床疗效。[方法]回顾性分析2009年4月~2012年3月内在本院行经皮椎体后凸成形术（A组,28例）或伤椎置钉联合硫酸钙椎体增强术（B组,19例）治疗的围绝经期胸腰椎骨折患者临床资料,比较两组患者卧床时间、填充物注射量、术前、术后2周和末次随访时椎体高度压缩率、Cobb角、疼痛视觉模拟评分（VAS）以及末次随访的功能障碍指数（ODI）评分变化。[结果]A组较B组患者卧床时间短,填充物注射量多（P〈0.05）。两组手术方式术后椎体高度压缩率、Cobb角、VAS评分均较术前明显改善（P〈0.05）,末次随访与术后2周相比,cobb角变化与VAS评分差异有统计学意义（P〈0.05）,而椎体高度压缩率无统计学意义（P〉0.05）。两组手术方式术前、术后2周、末次随访时体高度压缩率、Cobb角、ODI评分对比差异无统计学意义（P〉0.05）,术后2周A组患者VAS评分较B组低（P〈0.05）,而术前、末次随访时VAS评分比较差异无统计学意义（P〉0.05）。A组发生5例骨水泥渗漏,B组发生2例填充物渗漏,两组发生渗漏的患者均无明显临床症状。[结论]PKP手术与伤椎置钉联合硫酸钙椎体增强术均为治疗围绝经期妇女胸腰椎骨折的有效手段,外科医师应根据两种手术方式各自特点及患者实际情况选择合适的手术方式。[Objective]To compare clinical outcomes between percutaneous kyphoplasty and intermediate screws technique combined with injectable calcium sulfate for treatment of thoracolumbar fracture in postmenopausal patients. [Method]Postmenopausal patients with thoracolumbar fracture receiving surgical treatments in our hospital from April 2009 to March 2012 were retrospectively analyzed in this research. Tweaty-eiyht patients underwent percutaneous kyphoplasty（ Cohort A）. Nineteen patients were reconstructed with posterior internal fixation of intermediate screws technique and anterior vertebral augmentation of MIIGX3 technique（ Cohort B）. The change of fracture vertebral height,Cobb ＇s angle,Visual analogue scale（ VAS）,Oswestry Disability Index（ ODI） were involved in this research. [Result]Cohort A had a significant shorter bed site and much more injection dose than cohort B（ P 0. 05）. Fracture vertebral height,Cobb＇s angle and VAS had greatly improvements in both cohorts after procedures（ P 0. 05）. Cobb＇s angle,VAS had statistical difference 2 weeks after surgery and at final follow- up time（ P 0. 05）,but no difference was shown for the fracture vertebral height（ P 0. 05）. Fracture vertebral height,the Cobb＇ s angle and the ODI score had no statistical difference at any time between the two groups（ P 0. 05）. The VAS score in Cohort A was significant lower than the one in Cohort B at the 2 weeks after surgery（ P 0. 05）. This difference was not seen at neither the pre- operation time,nor the final follow- up time（ P 0. 05）. Five leakage cases happened in cohort A and two leakage cases happened in cohort B. No clinical deficiency occurred in either cohort. [Conclusion]PKP and intermediate screws combined with injectable calcium sulfate are both effective for osteoporotic thoracolumbar fracture. Surgeons should choose the suitable operationmethod depending on the characteristics of each operation method and the actual situation of surgery patients.

关 键 词：伤椎置钉 可注射硫酸钙 经皮椎体后凸成形术 围绝经期 胸腰椎骨折 

分 类 号：R687.3[医药卫生—骨科学]