PKP与椎体强化后椎弓根钉内固定治疗骨质疏松性胸腰椎爆裂骨折的比较研究  

Percutaneous kyphoplasty compared wi th pedicle screw fixation after vertebroplasty augmentation for osteoporotic thoracolumbar burst fractures

作　　者：崔冠宇[1] 田伟[1] 刘波[1] 袁强[1] 张贵林[1] 何达[1] 孙宇庆[1] 胡临[1] 李志宇[1] 

机构地区：[1]北京积水潭医院(北京大学第四临床医学院)脊柱外科,北京100035

出　　处：《中国骨与关节损伤杂志》2015年第7期690-693,共4页Chinese Journal of Bone and Joint Injury

基　　金：首都卫生发展专项资助项目(2011-2007-04);北京市医管局重点医学专业发展计划项目(ZL201405)

摘　　要：目的比较经皮球囊扩张椎体后凸成形术(PKP)与椎体强化后椎弓根钉内固定术治疗骨质疏松性胸腰椎爆裂骨折的疗效。方法回顾性分析自2008-06—2013-08应用PKP治疗的32例骨质疏松性胸腰椎爆裂骨折(A组)与应用聚甲基丙烯酸甲酯(PMMA)骨水泥强化后椎弓根钉内固定术治疗的21例骨质疏松性胸腰椎爆裂骨折(B组)的临床疗效。结果 A组手术时间、术中失血量显著低于B组(P<0.05)。B组节段性后凸角的矫正及矫正的维持、椎体高度的恢复及椎体高度恢复的维持均优于A组(P<0.05)。2组术前椎管内占位的差异无统计学意义(P>0.05),术后7 d B组椎管内占位显著低于A组(P<0.05),2组末次随访时椎管内占位都有进一步降低,但仍为B组显著低于A组(P<0.05)。2组术前、术后7 d的JOA、VAS评分的差异均无统计学意义(P>0.05),末次随访时B组的JOA评分显著高于A组(P<0.05),末次随访时B组的VAS评分显著低于A组(P<0.05)。2组均未出现骨折不愈合、内固定断裂和移位,A组1例出现相邻椎体再骨折再次接受PKP手术治疗。结论和PKP相比,应用PMMA骨水泥强化椎体后椎弓根钉内固定术在治疗骨质疏松性胸腰椎爆裂骨折可以获得更好的后凸矫正效果以及缓解疼痛、改善脊柱功能的疗效。Objective To compare the clinical outcomes between percutaneous kyphoplasty （PKP） and pedicle screw f＇Lxation after vertebroplasty augmentation using polymethylmethacrylate （PMMA） in the treatment of osteoporotie thoracolumbar burst fractures. Methods From June 2008 to August 2013, the clinical data of 32 patients with osteoporotie thoracolumbar burst fracture who underwent PKP（group A） and 21 patients who underwent pedicle screw fixation after vertebroplasty augmentation （group B） were retrospectively analyzed. Results Operation time and blood loss of group A were significantly less than those of group B. Group B had better kyphosis angle correction, better correction preservation, better regain of vertebral body height less and better preservation than group A （P 〈0.05）. There was no significant difference in spinal canal encroachment before operation between two groups （P 〉0.05 ）. At 7 d after operation and at final follow-up, spinal canal encroachment of group B were significantly less than that of group A （P 〈0.05）. There were no significant difference in JOA score, VAS score before and 7 d after operation between two groups （P 〉0.05）. At final follow-up, JOA score of group B was significantly larger than that of group A and VAS of group B was significantly less than that of group A （P 〈0.05）. There were no complications of non-union, breakage or migration of bone cement and internal fixation. In group A, one ease had a fracture in the adjacent vertebra and received another PKP. Conclusion Compared with PKP, pediele screw fixation after vertebroplasty augmentation using PMMA is a safe and effective treatment for osteoporotie thoracolumbar burst fractures with better kyphotic correction, pain alleviation and gain of spinal function.

关 键 词：胸椎 腰椎 爆裂骨折 椎弓根钉 聚甲基丙烯酸甲酯 

分 类 号：R687.3[医药卫生—骨科学]