不同手术方法治疗脊柱骨质疏松压缩性骨折的疗效分析

Outcome analysis of surgical interventions for osteoporotic vertebral compression fractures

目的比较不同手术方法治疗脊柱骨质疏松压缩性骨折（OVCF）的疗效。方法对自2005年3月至2009年3月治疗且获得随访的65例OVCF患者资料进行回顾性研究，其中男25例，女40例；年龄58～81岁，平均73岁；骨折部位：T10 5例，T11 8例，T12 14例；L1 15例，L2 13例，L3 10例。手术方法分为微创手术组（A组）和开放手术组（B组），A组又分为Sky手术组（Al组，20例）和球囊成形组（A2组，22例）。B组又分为双皮质固定组（B1组，10例）和骨水泥强化组（B2组，13例）。评价4组患者手术前、后疼痛评分、脊柱后凸变化及并发症发生情况，以及B组手术前、后的脊髓神经功能改善情况。结果所有患者术后获8～45个月（平均23个月）随访。A组疼痛评分、功能评分术后改善迅速；B组术后1个月左右的疼痛评分、功能评分较术前明显改善，差异有统计学意义（P〈0．05）；A1组手术前、后脊柱后凸的矫正效果差异无统计学意义（P〉0．05）。B组脊髓神经功能评分术后有明显改善，差异有统计学意义（P〈0．05）。A、B组均出现了相邻椎体的骨折。结论微创手术和开放手术都是治疗OVCF的有效方法，但两者有不同的适应证；微创手术在缓解疼痛方面迅速有效，但Sky手术在后凸矫形方面存在明显不足；手术后相邻节段的骨折是手术治疗OVCF的主要并发症。

Objective To compare the clinical outcomes of 2 surgical interventions for osteoporotic vertebral compression fractures （OVCF） . Methods Sixty-five patients with OVCF from March 2005 to March 2009 were included in this clinical study. They were 25 men and 40 women, aged from 58 to 81 years old （mean, 73 years old）. Five fractures occurred on T10, 8 on T11 , 14 on T12, 15 on L1, 13 one L2, and 10 on L3. Surgical treatments were minimally invasive surgery （group A） and open surgery （group B） . In group A, there were subgroup A1 （Sky bone expander） and subgroup A2 （balloon kyphoplasty）. Group B was divided into subgroup B1 （bicortical pedicle fixation） and subgroup B2 （bone cement enhanced pedicle fixation） . Pre- and postoperative functions, symptoms, kypbosis, and complications were evaluated for the 4 groups. Neurological functions before and after surgery were compared in open surgery groups. Results All procedures were performed successfully. The duration of follow-up ranged from 8 to 45 months （mean, 23 months） . Minimally invasive surgery obtained immediate pain relief and quick functional recovery. The visual analog scores （VAS） and functional scores one month after surgery were statistically improved in group B （ P 〈 0. 05）. The kyphosis in group A1 was not significantly changed after surgery （ P 〉 0. 05）. The neurological function improved significantly after surgery in Group B （ P 〈 0.05） . Adjacent vertebral fractures occurred after surgery in both group A and group B. Conclusions Pereutaneous kyphoplasty （PKP） and open reduction and fixation （ORF） are both effective treatments for OVCF, though they are differently indicated in clinic. PKP can offer instant pain relief, but Sky procedure is weak in terms of kyphotic correction. Postoperative adiacent vertebral fracture is the main comolication for OVCF.