经皮椎体成形术结合椎弓根螺钉治疗骨质疏松性脊柱骨折  

Percutaneous vertebroplasty combined with pedicle screw in treating osteoporotic vertebral fracture

作　　者：管俊杰[1] 陈向东[1] 陈晓庆[1] 成嘉祁 陈诚 浩洁 夏新雷 Guan Junjie;Chen Xiangdong;Chen Xiaoqing;Cheng Jiaqi;Chen Cheng;Hao Jie;Xia Xinlei(Department of Orthopedics,Affiliated Hospital of NantongUniversity,Nantong 226001,China;Department of Orthopedics,Huashan Hospital,Fudan University,Shanghai550001,China)

机构地区：[1]南通大学附属医院骨科,南通226001 [2]复旦大学附属华山医院骨科,上海550001

出　　处：《中华实验外科杂志》2024年第7期1428-1431,共4页Chinese Journal of Experimental Surgery

摘　　要：目的对比分析经皮椎体成形术(PVP)结合椎弓根螺钉内固定治疗与单一经皮椎体后凸成形术(PKP)在骨质疏松性椎体压缩性骨折(OVCF)中的应用价值。方法收集2020年1月至2021年12月南通大学附属医院骨科收治的98例OVCF患者临床资料, 其中46例行PVP+椎弓根螺钉内固定治疗(PVP+内固定组, 其中男20例, 女26例), 52例行单一PKP治疗(PKP组, 其中男24例, 女28例), 所有患者术后随访时间≥12个月。记录两组手术相关指标, 观察术前、术后1周及术后12个月伤椎参数及美国脊柱损伤协会(ASIA)等的变化, 并评估术后并发症发生情况, 符合正态分布的计量资料使用重复测量方差分析及LSD-t检验;计数数据采用χ^(2)检验或Fisher精确概率法。结果 PVP+内固定组手术时间明显高于PKP组[(103.47±12.55) min比(90.21±10.37) min, t=5.725, P<0.05], 术中出血量高于PKP组[(114.57±16.20) ml比(105.61±13.44) ml, t=2.991, P<0.05], 两组术中骨水泥渗漏率(0比1.92%)比较, 差异无统计学意义(P>0.05), 两组骨水泥注入量比较, 差异无统计学意义[(4.10±0.76) ml比(4.03±0.65) ml, t=0.481, P>0.05]。PVP+内固定组术后1周及术后12个月后凸Cobb角低于PKP组, [(3.35±0.72)°比(4.24±0.75)°、(3.56±0.68)°比(4.45±0.70)°, t=5.973、6.366, P<0.05], PVP+内固定组术后1周及术后12个月后椎体压缩率低于PKP组[(5.01±0.49)%比(6.71±0.40)%、(5.14±0.48)%比(6.99±0.42)%, t=18.897、20.350, P<0.05]。两组患者术后12个月ASIA分级均恢复至E级。两组术后随访期间均未发现螺钉松动、断裂及伤椎再骨折、邻近椎体骨折等并发症。结论单一PKP治疗的手术时间更短、出血量更少, 但椎弓根螺钉内固定复位后结合PVP治疗OVCF的椎体高度恢复较单一PKP治疗更理想。Objective To compare and analyze the application value of percutaneous vertebroplas-ty(PVP)combined with pedicle screw internal fixation and simple percutaneous kyphoplasty(PKP)on os-teoporotic vertebral compression fracture(OVCF).Methods The clinical data of 98 patients with OVCF in Department of Orthopedics of Affiliated Hospital of Nantong University from January 2020 to December 2021 were collected.Among the patients,46 cases underwent PVP+pedicle screw internal fixation(PVP+internal fixation group,including 20 males and 26 females)and 52 cases received simple PKP(PKP group,including 24 males and 28 females).All patients were followed up for≥12 months after sur-gery.The surgical related indicators were recorded in both groups,and the changes in injured vertebrae pa-rameters and American Spinal Injury Association(ASIA)were observed before surgery and at 1 week and 12 months after surgery,and the postoperative complications were evaluated.Repeated measurement analy-sis of variance and LSD-t test were used for measurement data conforming to normal distribution.Enumera-tion data were analyzed by Chi-square test or Fisher's exact test.Results The surgical time in PVP+in-ternal fixation group was significantly longer than that in PKP group p[(103.47±12.55)min vs.(90.21±10.37)min,t=5.725,P<0.05],and the intraoperative blood loss was more than that in PKP group[(114.57±16.20)ml vs.(105.61±13.44)ml,t=2.991,P<0.05],and comparison of bone cement leakage rate in the two groups(0 vs.1.92%)showed P>0.05 in Fisher's exact test.There was no statis-tically significant difference in the bone cement injection volume between the two groups[(4.10±0.76)ml vs.(4.03±0.65),t=0.481,P>0.05].The kyphosis Cobb angles in PVP+internal fixation group were smaller than those in PKP group at 1st week and 12th month after surgery[(3.35±0.72)°vs.(4.24±0.75)°,(3.56±0.68)°vs.(4.45±0.70)°,t=5.973,6.366,P<0.05].The vertebral compression rates in PVP+internal fixation group at 1st week and 12th month afer surgery were lower than thos

关 键 词：骨质疏松 椎体压缩性骨折 经皮椎体后凸成形术 经皮椎体成形术 椎弓根螺钉内固定 

分 类 号：R687.3[医药卫生—骨科学]