两种手术治疗骨质疏松胸腰椎爆裂骨折  

Effect of two kinds of surgeries for the treatment of osteoporotic thoracolumbar burst fracture

作　　者：孟祥翔[1] 翟亚业[1] 李晖[1] 顾夙[1] MENG Xiang-xiang;ZHAI Ya-ye;LI Hui;GU Su(Department of Orthopaedics,Central Hospital of Nanyang City,Nanyang 473000,China)

机构地区：[1]南阳市中心医院骨科,河南南阳473000

出　　处：《中国矫形外科杂志》2021年第6期507-511,共5页Orthopedic Journal of China

摘　　要：[目的]对比研究椎体强化短节段椎弓根螺钉固定(short-segment pedicle screw fixation, SPSF)与经皮后凸成形术(percutaneous kyphoplasty, PKP)治疗骨质疏松胸腰椎爆裂骨折的临床效果。[方法]回顾分析2016年1月~2019年1月本科手术治疗的91例患者,42例采用椎体骨水泥钉道强化SPSF治疗,49例采用PKP治疗。比较两组围手术期、随访与影像资料。[结果] SPSF组术中出血量及手术时间均显著大于PKP组(P<0.05),但两组术后住院时间及并发症发生率的差异无统计学意义(P>0.05)。随时间推移,两组患者的VAS和ODI评分均显著减少(P<0.05),末次随访时SPSF组的VAS评分及ODI评分均低于PKP组(P<0.05)。影像方面,与术前相比,术后两组局部后凸Cobb角、椎体前缘和后缘压缩比均显著改善(P<0.05);术后1周和末次随访时SPSF组的局部后凸Cobb角、椎体前缘和后缘压缩比均显著优于PKP组(P<0.05)。[结论]骨质疏松性胸腰椎爆裂性骨折采用骨水泥钉道强化SPSF治疗矫正效果优于PKP,可更好地缓解疼痛并改善脊柱功能。[Objective] To compare the clinical outcomes of vertebral augmentation combined with short-segment pedicle screw fixation(SPSF) and percutaneous kyphoplasty(PKP) for osteoporotic thoracolumbar burst fractures. [Methods] A retrospective study was conducted on 91 patients who received surgical treatment for osteoporotic thoracolumbar burst fractures in our hospital from January 2016 to January 2019. Of them, 42 patients underwent SPSF, while the remaining 49 patients received PKP. The perioperative, follow-up and radiographic documents were compared between 2 groups. [Results] The SPSF group was significantly inferior to the PKP group regarding intraoperative blood loss and operation time(P<0.05), despite of the fact that no statistical differences were noted in hospital stay and early complications between them(P>0.05). Both the VAS and ODI scores significantly deceased over time in 2 groups(P<0.05). The SPSF group proved significantly superior to the PKP group in VAS and ODI scores at the latest follow-up(P<0.05). In term of radiographic assessment,the local kyphotic Cobb’s angle, compression ratio of anterior and posterior vertebral height after operation were significantly improved in both groups compared with those before operation(P<0.05). The SPSF group was significantly superior to the PKP group in local kyphotic Cobb’s angle, compression ratio of anterior and posterior vertebral height at 1 week postoperatively and the latest follow up(P<0.05). [Conclusion] The vertebral augmentation combined with short-segment pedicle screw fixation does achieve better clinical outcomes than the percutaneous kyphoplasty for osteoporotic thoracolumbar burst fractures in term of correction of deformity, pain relief and functional recovery.

关 键 词：胸腰椎爆裂性骨折 骨质疏松 椎体增强 椎弓根 螺钉 经皮后凸成形 

分 类 号：R683.2[医药卫生—骨科学]