经皮椎弓根钉内固定并伤椎骨水泥强化与PKP治疗骨质疏松性胸腰椎压缩骨折疗效比较  

Comparison of percutaneous pedicle screw fixation combined with fractured vertebra cement augmentation and percutaneous kyphoplasty in treatment of osteoporotic thoracolumbar vertebral compression fractures

作　　者：邹伟[1] 肖杰[1] 张洋[1] 杜玉辉[1] 周昌俊[1] ZOU Wei;XIAO Jie;ZHANG Yang;DU Yu-hui;ZHOU Chang-jun(Department of Orthopedics,the Fourth People Is Hospital of Guiyang,Guiyang,Guizhou 550002,Chin)

机构地区：[1]贵阳市第四人民医院(贵阳骨科医院)脊柱外科,贵州550002

出　　处：《中国骨与关节损伤杂志》2018年第7期679-682,共4页Chinese Journal of Bone and Joint Injury

基　　金：贵阳市科技计划项目([20141001]20)

摘　　要：目的比较经皮椎弓根钉内固定并伤椎骨水泥强化与经皮椎体后凸成形术(PKP)治疗老年骨质疏松性胸腰椎压缩骨折的临床疗效。方法回顾性分析自2013-01—2016-01诊治的47例老年骨质疏松性胸腰椎压缩骨折,采用经皮椎弓根钉复位内固定并伤椎骨水泥强化治疗22例(联合组),采用单侧椎弓根穿刺PKP治疗25例(PKP组)。结果 47例均获得随访,随访时间平均13.2(12~26)个月。所有患者均未发生医源性神经损伤、内固定物异常、椎管内骨水泥渗漏等并发症。PKP组在切口长度、手术时间、术中出血量、X线暴露次数方面均明显优于联合组,差异有统计学意义(P<0.05)。术后3 d联合组在伤椎前缘高度比值、伤椎后缘高度比值、伤椎Cobb角方面均优于PKP组,差异有统计学意义(P<0.05)。末次随访时联合组在JOA评分、腰痛VAS评分、伤椎Cobb角矫正丢失方面均优于PKP组,差异有统计学意义(P<0.05)。结论经皮椎弓根钉内固定并伤椎骨水泥强化与PKP均为骨质疏松性胸腰椎压缩骨折理想的微创手术治疗方法,PKP手术创伤更小,止痛效果确切,但就矫正脊柱后凸畸形及恢复伤椎高度效果而言,经皮椎弓根钉内固定并伤椎骨水泥强化术优势明显。Objective To compare the clinical results between percutaneous pedicle screw fixation combined with fractured vertebra cement augmentation and percutaneous kyphoplasty in the treatment of aged osteoporotic thoracolumbar vertebral compression fractures. Methods Forty-seven patients with aged osteoporotic vertebral compression fractures between January2013 and January 2016 were analyzed retrospectively. Twenty-two patients（combined group） were treated with percutaneous pedicle screw fixation combined with fractured vertebra cement augmentation, while the other 25（PKP group） with unilateral percutaneous kyphoplasty. Results All patients were followed up for average 13.2（12-26） months. No complications of iatrogenic neurological injury, cement leakage in spinal canal and hardware failure occurred. PKP group was significantly better than combined group in the length of incision, operation time, intraoperative blood loss, X-ray exposure（ P〈0.05）.Combined group was significantly better than PKP group in the height of injury vertebrae and kyphotic angle on postoperative day 3（P〈0.05）. At the last follow-up, combined group was significantly better than PKP group in the VAS scores, JOA scores and correction loss（P〈0.05）. Conclusion Both percutaneous pedicle screw fixation combined with fractured vertebra cement augmentation and PKP are ideal therapeutic method in osteoporotic vertebral compression fractures. PKP has the advantages of less trauma and effectiveness to relieve the pain. Percutaneous pedicle screw fixation combined with fractured vertebra cement augmentation has obvious advantages in restoring the height of the injured vertebrae and correcting kyphotic deformity compared with PKP.

关 键 词：骨质疏松性胸腰椎压缩骨折 微创 经皮椎体后凸成形术 经皮椎弓根钉 内固定 

分 类 号：R687.3[医药卫生—骨科学]