经皮骨水泥强化复位内固定联合椎体成形术治疗Genant Ⅲ型骨质疏松性胸腰段骨折  

Percutaneous vertebroplasty combined with percutaneous cement-augmented reduction and internal fixation for osteoporotic thoracolumbar fractures of Genant type Ⅲ

作　　者：张正平[1] 昌震[1] 赵勤鹏[1] 曹子君[1] 黄琳红[1] 王栋琪[1] 许正伟[1] 刘团江[1] 郝定均[1] 

机构地区：[1]西安交通大学医学院附属红会医院脊柱外科,710054

出　　处：《中华创伤骨科杂志》2015年第6期497-501,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的 通过与经皮椎体后凸成形术（PKP）比较,观察经皮骨水泥强化复位内固定联合椎体成形术（PVP）治疗GenantⅢ型骨质疏松性胸腰段骨折的疗效. 方法 对2011年1月至2012年6月收治的56例骨质疏松性胸腰段骨折手术患者资料进行回顾性分析,根据治疗方式不同分为强化复位组（采用经皮骨水泥强化复位内固定联合PVP治疗,30例）和传统组（采用PKP治疗,26例）.两组患者术前一般资料比较差异均无统计学意义（P＞0.05）,具有可比性.记录并比较两组患者的手术时间、出血量、伤椎骨水泥用量、术后卧床时间、住院时间、伤椎前缘高度百分比、后凸cobb角、疼痛视觉模拟评分和Oswestry功能障碍指数问卷表（ODI）.结果 所有患者术后随访18～ 24个月,平均21个月.与传统组比较,强化复位组患者手术时间长、术中出血量大、伤椎骨水泥用量多、术后卧床时间和住院时间长,差异均有统计学意义（P＜0.05）.两组患者术后和术后12个月伤椎高度百分比、cobb角均较术前明显恢复,差异有统计学意义（P＜0.05）;强化复位组术后12个月伤椎前缘前缘高度百分比及cobb角较传统组恢复更明显,差异均有统计学意义（P＜0.05）.两组患者术后当天、3个月、12个月视觉模拟评分均较术前明显降低,差异有统计学意义（P＜0.05）.两组患者术后12个月ODI均较术前改善,差异有统计学意义（P＜0.05）;术后12个月ODI两组间比较,差异无统计学意义（P＜0.05）. 结论 相对于PKP来说,对于塌陷、成角严重的骨质疏松性胸腰段脊柱骨折,经皮骨水泥强化复内固定联合PVP可能是一种更可靠的治疗措施.Objective To evaluate the efficacy of percutaneous vertebroplasty （PVP） combined with percutaneous cement-augmented reduction and internal fixation for osteoporotic thoracolumbar fractures of Genant type Ⅲ by comparison with pure percutaneous kyphoplasty （PKP）.Methods From January 2011 through June 2012,we treated 56 patients with osteoporotic thoracolumbar fracture of Genant type Ⅲ.Of them,30 were managed by PVP combined with percutaneous cement-augmented reduction and internal fixation and 26 by pure PKP.The 2 groups were similar in general clinical data （P 〉 0.05）.They were compared in terms of operation time,blood loss,cement volume,postoperative bedridden time,hospital stay,ratio of anterior heights,cobb angle,visual analogue scale （VAS） scores and Oswestry disability index （ODI） scores.Results The patients were followed up for 18 to 24 months （average,21 months）.The PVP group exhibited significantly longer operation time,more blood loss,larger cement volume,and longer postoperative bedridden time and hospital stay than the PKP group （P 〈 0.05）.The ratios of anterior heights and cobb angles at immediate postoperation and 12 months postoperation in both groups were significantly improved compared with their preoperative ones （P 〈 0.05）.The improvements in ratio of anterior heights and cobb angle at 12 months postoperation in the PVP group were significantly larger than in the PKP group （P 〈 0.05）.The VAS scores at immediate postoperation,3 and 12 months postoperation in both groups were significantly decreased compared with the preoperative ones （P 〈 0.05）.The ODI scores at 12 months postoperation in both groups were significantly improved than the preoperative ones （P 〈 0.05）,but there were no significant differences in ODI scores between the 2 groups at 12 months postoperation （P 〉 0.05）.Conclusion PVP combined with percutaneous cement-augmented reduction and internal fixation may be reliable for osteoporotic thoracolumbar fractures with seve

关 键 词：脊柱骨折 骨质疏松 椎体成形术 骨水泥 

分 类 号：R687.3[医药卫生—骨科学]