微创椎弓根钉对经皮椎体成形术后再骨折的预防作用

Preventive Effects of Minimally Invasive Pedicle Screw Fixation on Secondary Fractures after Percutaneous Vertebroplasty

目的：探讨微创椎弓根钉对经皮椎体成形术（ percutaneous vertebroplasty， PVP ）后再骨折的预防作用。方法选取2010年11月～2011年8月68例单节段胸腰椎新鲜骨折且无神经症状分为2组：单纯PVP组（ n＝37），只行双侧PVP；PVP联合内固定组（（ n＝31），行双侧PVP＋微创椎弓根钉内固定术。比较2组手术时间、术中出血量、术前后腰背痛VAS评分、椎体高度压缩率、后凸角及术后各时点椎体高度恢复率和后凸矫正率。结果单纯PVP组骨水泥注入量（5．7±1．1）ml，手术时间（43．4±5．0） min，出血量（5．5±1．5）ml，住院时间（3．2±0．4） d。 PVP联合内固定组骨水泥注射量（6．1±1．4）ml，手术时间（74．7±8．6）min，出血量（70．2±4．7）ml，无一例需要输血，住院时间（5．3±1．0）d。术后平均随访26个月（24～30个月）。 PVP联合内固定组术后1、2、3个月VAS疼痛评分显著低于单纯PVP组（ P＜0．05）。单纯PVP组术后各时点椎体高度压缩率显著高于PVP联合内固定组（ P＜0．05）；2组内椎体高度压缩率术前与术后各时点比较均有统计学差异（P＜0．05）。单纯PVP组术后各时点椎体高度恢复率显著低于PVP联合内固定组（P＜0．05）；单纯PVP组椎体高度恢复率术后即刻与术后其他时点比较差异有显著性（P＜0．05），PVP联合内固定组术后各时点比较差异无显著性（P＞0．05）。单纯PVP组术后各时点椎体后凸角显著高于PVP联合内固定组（P＜0．05）；2组椎体后凸角术后即刻与术后其他时点比较差异有显著性（P＜0．05）。单纯PVP组术后各时点椎体后凸矫正率显著低于PVP联合内固定组（P＜0．05）；单纯PVP组椎体后凸矫正率术后即刻与术后其他时点比较差异有显著性（P＜0．05），PVP联合内固定组术后各时点比较差异无显著性（P＞0．05）。单纯PVP组5例（13．5％）出现再骨折，9例（24．3％）出现邻近椎体骨折；PVP联合内固定组无一例出现手术椎体再骨折、邻近椎体或内固定邻近椎体骨折、螺钉松动、断钉断棒。结论胸腰椎骨质疏松性骨折时采用PVP联合微创椎弓根钉内固定可以防止PVP后再骨折的发生。

Objective To evaluate the feasibility and safety of minimally invasive pedicle screw fixation combined with percutaneous vertebroplasty （ PVP） for treating acute thoracolumbar osteoporotic vertebral compression fracture （ VCF） and preventing the secondary VCF. Methods Sixty-eight patients, with a mean age of 74.5 years old （range, 65-87 years old）, who sustained thoracic or lumbar fresh osteoporotic VCFs without neurologic deficits underwent the procedure of PVP （ group 1, n=37） or minimally invasive pedicle screw fixation combined with PVP （group 2, n=31） from November 2010 to August 2011.Visual analog scale pain scores （ VAS） were recorded and the Cobb angles and the anterior vertebral body height were measured on the lateral radiographs before surgery and immediately, 1 month, 2 months, 3 months, 6 months, 1 year, and 2 years after surgery. Results In the group 1, the bone cement use was （5.7 ±1.1） ml, the operation time was （43.4 ±5.0） min, the blood loss was （5.5 ±1.5） ml, and the length of hospital stay was （3.2 ±0.4） d.In the group 2, the bone cement use was （6.1 ±1.4） ml, the operation time was （74.7 ±8.6） min, the blood loss was （70.2 ±4.7） ml, and the length of hospital stay was （5.3 ±1.0） d.No blood transfusion was needed.The patients were followed for an average of 26 months （ range, 24-30 months） .The VAS was significantly lower in the group 2 than that of group 1 at 1 month, 2 months, 3 months after surgery （P〈0.05）.The Cobb angle （group 1, F=8.23,P=0.000;group 2, F=38.22,P=0.000） and the compression rate of vertebral body height （group 1, F=34.86,P=0.000; group 2, F=71.88,P=0.000） were significantly decreased immediately after surgery in both groups.No significant changes in both the Cobb angle correction and the vertebral body height gains were observed at the end of the follow-up period in group 2（F=0.54,P=0.775;F=2.28,P=0.038）.In the group 1, there were 5 patients （13.5%） with new fracture of operated vertebrae and 9 cases （24.3%） with fracture of adjacent vertebrae.While in the group 2, no recurrence of fracture was recorded. Conclusion Minimally invasive pedicle screw fixation combined with PVP is a good choice for the treatment of acute thoracolumbar osteoporotic VCF, which can prevent the occurrence of new VCF after PVP.