两种术式治疗胸腰椎椎体压缩性骨折的疗效比较  

Comparative evaluation of two surgical methods treating patients with thoracolumbar vertebral compression fractures

作　　者：孙英飞[1] 韦宏宇[1] 移平[1] SUN Yingfei;WEI Hongyu;YI Ping(Department of Spine Surgery,ChinarJapan Friendship Hospital,Beijing 100029,China)

机构地区：[1]中日友好医院脊柱外科,北京100029

出　　处：《国际骨科学杂志》2021年第2期110-114,共5页International Journal of Orthopaedics

摘　　要：目的观察经皮椎体成形术(PVP)、经皮球囊扩张椎体后凸成形术(PKP)对胸腰椎椎体压缩性骨折患者脊柱-骨盆矢状位参数的影响。方法回顾性分析2016年5月至2018年5月在中日友好医院接受PVP或PKP治疗的120例新鲜单节段胸腰椎椎体压缩性骨折患者临床资料,按术式分为PVP组(67例)和PKP组(53例),比较两组手术情况、脊柱-骨盆矢状位参数、术后椎体恢复情况及疼痛、功能障碍情况。结果两组围手术期未见并发症发生,但PVP组手术时间、骨水泥注入量均显著少于PKP组,骨水泥渗漏率显著高于PKP组。术后两组腰椎前凸角(LL)、骶骨倾斜角(SS)较术前显著增加,骨盆倾斜角(PT)、C_(7)~S_(1)矢状面轴向距离(SVA)较术前显著减少,但PVP组与PKP组间差异无统计学意义(P>0.05)。末次随访时,两组椎体压缩程度差异无统计学意义(P>0.05),但PVP组椎体高度恢复率显著低于PKP组,椎体高度丢失率显著高于PKP组(P<0.05)。术后两组疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)均较术前显著下降,但PVP组VAS、ODI评分显著高于PKP组(P<0.05)。结论PVP与PKP治疗胸腰椎椎体压缩性骨折均能在一定程度上恢复脊柱-骨盆矢状位整体平衡,但PKP骨水泥渗漏率较低,术后椎体高度恢复及功能障碍改善也较为显著。Objective To observe the effects of percutaneous vertebroplasty(PVP)and percutaneous kyphoplasty(PKP)on spinalpelvic sagittal parameters in patients with thoracolumbar vertebral compression fractures(TVCF).Methods The clinical data of 120 patients with fresh single-segment TVCF undergoing PVP or PKP in the hospital from May 2016 to May 2018 were retrospectively analyzed.According to the surgical methods,patients were divided into the PVP group(n=67)and PKP group(n=53).The general surgical situations,spinalpelvic sagittal parameters,postoperative vertebral recovery,pain and dysfunction were compared between both groups.Results No serious complications were observed in any group.The operation duration and injection volume of bone cement in the PVP group were significantly lower than those in the PKP group,while the leakage rate of bone cement was significantly higher than that in the PKP group.Postoperatively,lumbar lordosis and sacral slope were significantly increased in both groups,while pelvic tilt and C_(7)sagittal vertical axis were significantly decreased;there was no significant difference between both groups(P<0.05).There was no significant difference in rate of vertebral compression between the two groups.At the last follow-up,recovery rate of vertebral height in the PVP group was significantly lower than that in PKP group,while loss rate of vertebral height was significantly higher than that in the PKP group(P<0.05);there was no significant difference in rate of vertebral compression between both groups.The visual analogue scale and Oswestry dysfunction index in both groups were significantly decreased postoperatively,but they were significantly higher in the PVP group compared with those of the PKP group(P<0.05).Conclusion Both PVP and PKP can recover the overall spine-pelvic sagittal balance to certain extent in the treatment of TVCF.The leakage rate of bone cement resulting from PKP is lower than the PVP,thus facilitating postoperative vertebral height recovery and dysfunction improvement.

关 键 词：经皮椎体成形 经皮球囊扩张椎体后凸成形 胸腰椎椎体压缩性骨折 脊柱-骨盆矢状位参数 

分 类 号：R687.3[医药卫生—骨科学]