比较椎体支柱块与球囊扩张椎体后凸成形术治疗单纯胸腰椎压缩骨折的临床疗效

Clinical comparison of pillar block and PKP for treatment of thoracolumbar compression fractures

目的分析椎体支柱块植入术（Pillar）和微创经椎弓根球囊扩张椎体后凸成形术（PKP）治疗单纯胸腰椎压缩骨折的临床疗效。方法自2012-09—2013-05采用Pillar植入和PKP 2种方法治疗单纯胸腰椎压缩骨折61例,包括Pillar组23例,25个椎体,PKP组38例,42个椎体。结果 61例获得随访14~22（18.2±6.3）个月。Pillar组平均手术时间、平均术中失血量均大于PKP组,差异有统计学意义（P〈0.05）。2组内在术前、术后ODI评分差异有统计学意义（P〈0.05）,2组间在术前、术后ODI评分差异无统计学意义（P〉0.05）。2组内术后的后凸Cobb角、伤椎前缘高度恢复情况均较术前明显改善,差异有统计学意义（P〈0.05）。取末次随访时后凸Cobb角、伤椎前缘高度作比较,Pillar组指标改善情况优于PKP组,差异有统计学意义（P〈0.05）。结论采用Pillar和PKP治疗单纯胸腰椎压缩骨折均能获得理想的临床疗效,两者均具有操作简单、手术时间短、术中出血量少、术后并发症较少、有效缓解疼痛等优点,能明显恢复伤椎高度,但Pillar在Cobb角的矫正及伤椎前缘高度恢复方面优于PKP。

Objective To assess the surgical therapeutic result of thoracolumbar compression fractures by minimally invasive vertebral pillar block insertion through pedicle or percutaneous kyphoplasty. Methods From Sept. 2012 to May 2013, 61 cases of thoracolumbar compression fracture patients（vertebrae） were divided into two groups： Pillar group, 23 cases who underwent minimally invasive vertebral pillar block insertion through pedicle for thoracolumbar compression fractures; PKP group, 38 cases who underwent percutaneous kyphoplasty for thoracolumbar compression fractures. Results All of the 61 cases were followed up for 14-22 months, average（18.2±6.3）months. In group Pillar, the average operation time and average intraoperative blood loss were higher than those in PKP group, the difference was statistically significant（ P〈0.05）. There were significant difference with respect to the Cobb angle, anterior height of vertebral body and ODI before and after operation（ P〈0.05） in both groups. At the last follow-up, the Cobb angle and anterior height of vertebral body correcting effect in Pillar group was much better than that in PKP group（P〈0.05）. Conclusion Both minimally invasive vertebral pillar block insertion through pedicle and percutaneous kyphoplasty are effective and safe in the treatment of thoracolumbar compression fractures,while the former is better than PKP due to its Cobb angle correction and anterior vertebral height restoration.