基于多准则决策的球囊扩张联合撬拨复位植骨治疗胸腰椎骨折风险-效益评价  

Risk and benefit evaluation of balloon dilation combined with prying reduction and bone grafting for thoracolumbar fractures based on multi-criteria decision

作　　者：魏然 贺银川 姚雪莹 曹鹏 刘明昊 许俊岭[1] WEI Ran;HE Yin-chuan;YAO Xue-ying;CAO Peng;LIU Ming-hao;XU Jun-ling(Department of Orthopedics,Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine,Cangzhou,Hebei,061000,China)

机构地区：[1]河北省沧州市中西医结合医院骨外科,061000

出　　处：《中国骨与关节杂志》2025年第3期214-221,共8页Chinese Journal of Bone and Joint

基　　金：河北省卫生健康委科研基金项目(20200612)。

摘　　要：目的探讨球囊扩张(balloon dilation,BD)联合撬拨复位植骨预防胸腰椎骨折(osteoporotic thoracolumbar fracture,OTF)术后迟发性后凸畸形的临床价值。方法选取2020年1月至2022年7月我院收治的72例Denis A型胸腰椎压缩性骨折(thoracolumbar compression fractures,TLCF)患者为研究对象,采用随机数字表法,分为观察组(BD联合撬拨复位植骨术)和对照组[短节段椎弓根钉撑开固定术(short-segment pedicle screw fixation,SPSF)],每组36例。分别于手术前后采用X线机观察患者椎体相对高度和Cobb’s角,对比两组患者的Oswestry功能障碍指数(Oswestry dysfunction index,ODI)、视觉模拟评分(visual analogue scale,VAS)、巴塞尔指数(Barthel index,BI)及神经功能Frankel分级(B~E级)等临床资料。建立BD联合撬拨复位植骨治疗OTF的多准则决策分析(Multi-criteria decision analysis,MCDA)模型。结果两组患者的手术时间、术中出血量、临床疗效及不良反应发生情况差异均有统计学意义(P<0.05);经手术治疗后,两组患者伤椎前缘高度(anterior vertebral height,AVH)、伤椎中线高度、伤椎后缘高度、Cobb’s角、ODI、BI指数、VAS评分及神经功能Frankel分级差异均有统计学意义(P<0.05)。观察组的效益高、风险低,100%优于对照组。MCDA模型的稳定性较好。结论与SPSF相比,BD联合撬拨复位植骨治疗OTF的获益高于风险,是治疗OTF的理想方法,可重建和维持伤椎高度,维持脊柱的稳定性,有效降低后凸畸形的发生率。Objective To explore the clinical value of balloon dilation(BD)combined with prying reduction and bone grafting in preventing delayed kyphosis after osteoporotic thoracolumbar fracture(OTF)surgery.Methods Denis A type thoracolumbar compression fractures(TLCF)patients(72 cases)admitted to our hospital from January 2020 to July 2022 were selected as the research subjects.Random number table method was used and all patients were divided into observation group(BD combined with prying reduction and bone grafting surgery)and control group[short-segment pedicle screw fixation(SPSF)],with 36 cases in each group.X-ray was used to observe the relative vertebral height and Cobb’s angle of patients before and after surgery,and clinical data such as Oswestry dysfunction index(ODI),visual analogue(VAS)score,barthel index(BI),and Frankel grading of neurological function(B-E)were compared between the two groups of patients.Multi-criteria decision analysis(MCDA)model was established for the treatment of OTF with BD combined with prying reduction and bone grafting.Results There were significant differences in surgical time,intraoperative blood loss,clinical efficacy,and incidence of adverse reactions between the two groups of patients(P<0.05).After surgical treatment,there were significant differences between the two groups of patients in terms of anterior vertebral height(AVH),midline vertebral height,posterior vertebral height,Cobb’s angle,ODI,BI index,VAS score,and Frankel grading of neurological function(P<0.05).The observation group had more benefits and lower risks,with 100%superiority over the control group.The stability of the MCDA model was good.Conclusions Compared with SPSF surgery,the benefits of BD combined with prying reduction and bone grafting are more than the risks for treating OTF,making it an ideal method.Meanwhile,it can reconstruct and maintain the height of the injured vertebra and spinal stability,further effectively reduce the incidence of kyphosis.

关 键 词：脊柱骨折 胸椎 腰椎 骨折固定术 内 治疗结果 

分 类 号：R683.2[医药卫生—骨科学]