球囊扩张经皮椎体后凸成形术联合撬拨复位植骨治疗胸腰椎骨折的疗效  

Efficacy of balloon dilation percutaneous kyphoplasty combined with prying reduction and bone grafting in the treatment of thoracolumbar fractures

作　　者：曹鹏 贺银川 姚雪莹[1] 魏然 刘明昊 赵爱军[1] 许俊岭[1] Cao Peng;He Yinchuan;Yao Xueying;Wei Ran;Liu Minghao;Zhao Ajun;Xu Junling(Department of Orthopedics,Cangzhou Integrated Traditional Chinese and Western Medicine Hospital of Hebei Province,Cangzhou 061000,China)

机构地区：[1]河北省沧州中西医结合医院骨外科,沧州061000

出　　处：《中国医师进修杂志》2023年第9期826-831,共6页Chinese Journal of Postgraduates of Medicine

基　　金：河北省卫生健康委科研基金项目(20200612)。

摘　　要：目的:探究球囊扩张经皮椎体后凸成形术(PKP)联合撬拨复位植骨治疗胸腰椎骨折的疗效,及其对患者神经功能的影响。方法:回顾性分析2017年3月至2020年5月河北省沧州中西医结合医院184例胸腰椎骨折患者的临床资料。其中,采用球囊扩张PKP联合撬拨复位植骨治疗86例(联合组),采用切开复位减压内固定治疗98例(内固定组)。记录术中出血量、手术时间、术中透视次数、疗效和并发症。术后1年,拍摄X线片测量椎体前后缘高度和Cobb角,评估疼痛视觉模拟评分(VAS)、Barthel指数和神经功能Frankel分级。结果:联合组术中出血量和手术时间明显大于内固定组[(205.64 ± 45.63)ml比(180.37 ± 30.08)ml和(110.22 ± 28.91)min比(81.66 ± 20.77)min],差异有统计学意义( P<0.01);两组术中透视次数比较差异无统计学意义( P>0.05)。联合组总有效率明显高于内固定组[91.86%(79/86)比79.59%(78/98)],总并发症发生率明显低于内固定组[13.95%(12/86)比38.78%(38/98)],差异有统计学意义( P<0.05或<0.01)。联合组术后1年患椎前后缘高度明显大于内固定组[(95.78 ± 1.59)mm比(62.74 ± 1.80)mm和(98.53 ± 3.80)mm比(95.06 ± 3.28)mm],Cobb角明显小于内固定组[(6.53 ± 2.80)°比(18.06 ± 2.68)°],差异有统计学意义( P<0.01)。两组术后1年VAS和Barthel指数明显改善,差异有统计学意义( P<0.01),但两组比较差异无统计学意义( P>0.05)。联合组术后1年神经功能Frankel E级率明显高于内固定组[56.98%(49/86)比23.47%(23/98)],差异有统计学意义( P<0.01)。 结论:与切开复位减压内固定治疗相比,胸腰椎骨折患者采用球囊扩张PKP联合撬拨复位植骨治疗可更好地实现患椎复位和畸形修复,安全性更高,减轻疼痛更明显,日常生活功能和神经功能恢复更好。Objective To explore the efficacy of balloon dilation percutaneous kyphoplasty(PKP)combined with prying reduction bone grafting in the treatment of thoracolumbar fractures,and its impact on patients'neurological function.Methods The clinical data of 184 patients with thoracolumbar fractures from March 2017 to May 2020 in Cangzhou Integrated Traditional Chinese and Western Medicine Hospital of Hebei Province were retrospectively analyzed.Among them,86 patients were treated with balloon dilation PKP combined with prying reduction and bone grafting(combined group),and 98 patients were treated with open reduction decompression and internal fixation(internal fixation group).The intraoperative bleeding volume,surgical time,intraoperative fluoroscopy frequency,efficacy and complications were recorded.One year after surgery,X-ray films were taken to measure the height of the anterior border and posterior border of vertebral body and the Cobb angle,and the pain visual analogue score(VAS),Barthel index and neurological Frankel grade were evaluated.Results The intraoperative bleeding volume and surgical time in combined group were significantly higher than those in internal fixation group:(205.64±45.63)ml vs.(180.37±30.08)ml and(110.22±28.91)min vs.(81.66±20.77)min,and there were statistical differences(P<0.01);there was no statistical difference in intraoperative fluoroscopy frequency between the two groups(P>0.05).The total effective rate in combined group was significantly higher than that in internal fixation group:91.86%(79/86)vs.79.59%(78/98),the total incidence of complications was significantly lower than that in internal fixation group:13.95%(12/86)vs.38.78%(38/98),and there were statistical differences(P<0.05 or<0.01).The height of the anterior border and posterior border of vertebral body 1 year after surgery in combined group were significantly higher than those in internal fixation group:(95.78±1.59)mm vs.(62.74±1.80)mm and(98.53±3.80)mm vs.(95.06±3.28)mm,the Cobb angle was significantly smaller than th

关 键 词：脊柱骨折 胸椎骨 腰椎骨 治疗结果 球囊扩张 撬拨复位植骨 

分 类 号：R687.3[医药卫生—骨科学]