球囊扩张硫酸钙骨水泥椎体增强与后外侧植骨融合治疗胸腰椎爆裂性骨折的疗效比较

Balloon vertebroplasty reinforced by injectable calcium sulfate cement versus posterolateral fusion for treatment of thoracolumbar burst fractures

目的比较球囊扩张硫酸钙骨水泥（CSC）椎体增强与后外侧植骨融合结合短节段经伤椎椎弓根钉固定治疗胸腰椎爆裂性骨折的疗效。方法对2011年6月至2013年12月手术治疗的44例胸腰椎爆裂性骨折患者资料进行回顾性研究，男30例，女14例；年龄20～60岁，平均42．5岁。根据治疗方法不同分为球囊扩张CSC椎体增强组（PKP组，22例，采用短节段经伤椎椎弓根复位、固定，再通过球囊扩张复位伤椎塌陷终板并注入CSC治疗）和后外侧植骨组（植骨融合组，22例，采用短节段经伤椎椎弓根复位、固定及后外侧植骨治疗）。比较分析两组患者术前、术后、内固定取出前及末次随访时视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）、伤椎前缘高度比、伤椎中央高度比、伤椎楔变角、矢状面cobb角等指标。结果所有患者术后获18～46个月（平均24个月）随访。所有患者术后和末次随访时的VAS评分和ODI均较术前改善，差异有统计学意义（P〈0．05）。术后1周的VAS评分和ODI与末次随访时比较，差异均无统计学意义（P〉0．05）。术后1周伤椎中央高度比和伤椎楔变角间两组间比较差异均有统计学意义（P〈0．05），PKP组优于植骨融合组。末次随访时伤椎前缘高度比、伤椎中央高度比、伤椎楔变角、矢状面cobb角两组间比较差异均有统计学意义（P〈0．05），PKP组矫正丢失更少。结论球囊扩张CSC椎体增强较后外侧植骨融合早期可更好地恢复伤椎形态和脊柱前、中柱的稳定性，减少矫正度丢失，并在内固定取出后保留了脊柱运动节段功能。

Objective To compare the clinical curative effects of balloon vertebroplasty reinforced by injectable calcium sulfate cement （CSC） and posterolateral fusion after short-segment pedicle screw fixation through the fractured vertebra in treatment of thoracolumbar burst fractures. Methods From June 2011 to December 2013, 44 patients with single thoracolumbar burst fracture were admitted by our department. They were 30 men and 14 women, from 20 to 60 years of age（average, 42. 5 years）. Of them, 22 were treated by short-segment pedicle screw fixation through the fractured vertebra followed by transpedicular balloon reduction of the endplate and CSC injection （PKP group）, the others underwent posterolateral fusion in addition to short-segment pedicle screw fixation through the fractured vertebra （fusion group） . The 2 groups were com- pared at preoperation, one week postoperation and the last follow-up in terms of visual analogue scale （VAS）, Oswestry disability index （ODI）, anterior height ratio of the injured vertebra, middle height ratio of the in- jured vertebra, the vertebral wedge angle and the sagittal cobb angle. Results The patients were followed up for an average of 24 months （range, from 18 to 46 months）. All the measure indexes at one week postop- eration and the last follow-up were significantly improved than those at preoperation in all the patients （P 〈0.05）, but there were no significant differences in all the measure indexes between one week postopertion and the last follow-up （ P 〉 0.05）. There was no significant between-group difference in the VAS score or ODI at either one week postoperation or the last follow-up （ P 〉 0. 05）. At one week postoperation, the middle height ratio of the injured vertebra and the vertebral wedge angle in the PKP group were significantly better than in the fusion group （ P 〈 0. 05）. At the last follow-up, the PKP group showed a significantly less loss than the fusion group regarding the corrections of anterior height ratio of the injured vertebra, middle height ratio of the injured vertebra, the verebral wedge angle and the sagittal cobb angle （ P 〈 0. 05）. Conclusions In treatment of thoracolumbar burst fractures, compared with posterolateral fusion, balloon vertebroplasty reinforced by injectable CSC can better restore the shape of injured vertebral body and stability of the anterior and middle columns in the early period, and can also reduce losses of corrections.