闭合复位内固定联合经皮椎体后凸成形术治疗老年股骨转子间骨折合并骨质疏松性椎体压缩骨折的疗效  

Efficacy of closed reduction and internal fixation combined with percutaneous kyphoplasty in the treatment of intertrochanteric fracture combined with osteoporotic vertebral compression fracture in the elderly

作　　者：荆峰[1] 陈超[1] 赵栋[1] 刘钢[1] 张银光[2] 董强[2] 刘天盛 王敬博[2] 赵嘉国[2] 徐宝山[1] 苗军[1] 马信龙[1] 杨强[1] Jing Feng;Chen Chao;Zhao Dong;Liu Gang;Zhang Yinguang;Dong Qiang;Liu Tiansheng;Wang Jingbo;Zhao Jiaguo;Xu Baoshan;Miao Jun;Ma Xinlong;Yang Qiang(Department of Spine Surgery,Tianjin Hospital,Tianjin 300211,China;Department of Orthopedic Trauma,Tianjin Hospital,Tianjin 300211,China)

机构地区：[1]天津市天津医院脊柱外科,天津300211 [2]天津市天津医院创伤骨科,天津300211

出　　处：《中华创伤杂志》2025年第1期33-42,共10页Chinese Journal of Trauma

基　　金：天津市科技重大专项与工程“揭榜挂帅”重大项目(21ZXJBSY00130);京津冀基础研究合作专项(J23000)。

摘　　要：目的比较闭合复位内固定联合经皮椎体后凸成形术(PKP)与非手术治疗老年股骨转子间骨折合并骨质疏松性椎体压缩骨折(OVCF)的疗效。方法采用回顾性队列研究分析2020年6月至2023年6月天津市天津医院收治的59例股骨转子间骨折合并OVCF患者的临床资料,其中男16例,女43例;年龄66~91岁[(80.2±6.8)岁]。伤椎节段:T_(10)3例,T_(11)9例,T_(12)18例,L_(1)17例,L_(2)8例,L34例。椎体骨折Genant半定量分级:1级42例,2级17例。股骨转子间骨折AO分型:A1型33例,A2型21例,A3型5例。患者均行股骨转子间骨折闭合复位内固定术,其中26例术后3 d行PKP治疗(PKP组),33例术后行非手术治疗(非手术组)。观察2组内固定术后2周髋部切口愈合和术后6个月股骨转子间骨折愈合情况。比较2组PKP术前、术后即刻、术后3个月及末次随访时腰背痛视觉模拟评分(VAS);PKP术前、术后3个月及末次随访时Oswestry功能障碍指数(ODI)、伤椎前缘高度比、伤椎后凸Cobb角。比较2组内固定术后3个月及末次随访时Harris髋关节功能评分。观察骨水泥渗漏情况。比较2组内固定术后下肢深静脉血栓(DVT)发生率。结果患者均获随访10~46个月[(25.5±9.9)个月]。2组内固定术后2周髋部切口均Ⅰ期愈合,术后6个月股骨转子间骨折均骨性愈合。2组PKP术前腰背痛VAS、ODI差异均无统计学意义(P>0.05)。PKP术后即刻、术后3个月及末次随访时,PKP组腰背痛VAS分别为(2.6±0.6)分、(2.4±0.9)分、(1.5±0.5)分,均低于非手术组的(8.2±0.8)分、(3.7±1.2)分、(3.3±0.6)分(P<0.01)。PKP术后3个月及末次随访时,PKP组ODI分别为(21.4±6.9)%、(16.2±6.3)%,均低于非手术组的(38.6±11.6)%、(32.7±12.0)%(P<0.01)。2组PKP术后各时间点腰背痛VAS、ODI均较术前逐渐改善(P<0.05或0.01)。2组PKP术前伤椎前缘高度比、伤椎后凸Cobb角差异均无统计学意义(P>0.05)。PKP术后3个月及末次随访时,2组伤椎前缘高度比分别为(79Objective To compare the efficacy of closed reduction and internal fixation combined with percutaneous kyphoplasty(PKP)and non⁃operative treatment for intertrochanteric fracture combined with osteoporotic vertebral compression fracture(OVCF)in the elderly.Methods A retrospective cohort study was conducted to analyze the clinical data of 59 patients with intertrochanteric fracture combined with OVCF admitted to Tianjin Hospital from June 2020 to June 2023,including 16 males and 43 females,aged 66-91 years[(80.2±6.8)years].The injured vertebral segments included T10 in 3 patients,T11 in 9,T12 in 18,L1 in 17,L2 in 8,and L3 in 4.According to the Genant semi-quantitative classification of vertebral fracture,42 patients were scaled into grade 1 and 17 into grade 2.Based on the AO classification of intertrochanteric fracture,33 patients were classified as type A1,21 type A2,and 5 type A3.All the patients underwent closed reduction and internal fixation for intertrochanteric fractures,among whom 26 patients received PKP after the internal fixation of OVCF(PKP group)and 33 patients received non-surgical treatment after the internal fixation of OVCF(non-surgical group).The healing of the hip incision at 2 weeks after internal fixation and the healing of intertrochanteric fractures at 6 months after surgery were observed in both groups.The visual analogue scale(VAS)for low back pain was compared between the two groups before PKP,immediately after PKP,at 3 months after PKP,and at the last follow-up.The Oswestry disability index(ODI),anterior vertebral height ratio,and Cobb angle of the injured vertebrae were compared between the two groups before PKP,at 3 months after PKP,and at the last follow-up.The Harris hip function score was compared between the two groups at 3 months after internal fixation and at the last follow-up.Cement leakage was observed.The incidence of deep vein thrombosis(DVT)in the lower extremities after internal fixation were compared between the two groups.Results All the patients were followed up for

关 键 词：骨质疏松 脊柱骨折 股骨骨折 椎体成形术 

分 类 号：R683.2[医药卫生—骨科学]