经皮椎弓根螺钉联合经皮椎体成型术治疗骨质疏松性椎体压缩性骨折的临床研究

THE COMBINED USE OF PERCUTANEOUS VERTEBROPLASTY AND THERAPY OF USING PERCUTNAEOUS PEDICLE SCREW(PPS)IN TREATING OSTEOPOROTIC VERTEBRAL COMPRESSION FRACTURES

目的探讨经皮椎体成形术联合经皮椎弓根螺钉技术治疗骨质疏松性压缩性骨折的临床效果,为老年患者骨质疏松性压缩性骨折提供新的治疗措施。方法以43例无神经症状的骨质疏松性椎体压缩性骨折的患者为研究对象,平均年龄为74.1岁(67~85岁)。随机分为两组,一组为单独行经皮椎体成型术(PVP)(n=25),一组为联合PVP和经皮椎弓根螺钉(PPS)手术组(n=18),利用疼痛视觉评分(VAS)评分以及椎体高度的恢复对患者术前、术后第2天、术后3个月和末次随访进行评估。并行CT检查,观察关节突退变情况。结果患者平均随访时间为21.6个月,两组术后VAS评分均显著降低(P<0.01);术后早期两组患者在椎体高度恢复良好,两组差异无显著性(P>0.05);末次随访发现PVP组出现椎体高度显著降低,并且3例患者出现伤椎的再次骨折,5例患者出现临近椎体的再次骨折,而联合组末次随访未发现新鲜骨折病例,联合组关节突间隙狭窄较PVP组广泛(P<0.01)。结论 PVP联合PPS为治疗骨质疏松引起的胸腰椎新发骨折提供了新的选择,并可以有效减少椎体的再次骨折和相邻阶段的骨折的发生,但PPS易增加相邻节段的退变速度。

Objective To explore the clinical effect of the combined use of percutaneous vertebroplasty （PVP） and therapy of using percutnaeous pedicle screw （PPS） on osteoporotic vertebral compression fractures （OVCF）. Methods 43 cases of OVCF without neural symptoms, with their mean age being 74. 1 （range from 67 to 85）, were randomly divided into two groups. Group One of 25 cases received the PVP treatment, and Group Two of 18 cases received the both PVP and therapy of using PPS. The Visual Analogue Scale results and vertebral heights were assessed before operation, two days after operation, three months after operation and in the last follow-up survey. CT scans were used to observe the degeneration of the zygapophysial joints. Results The mean follow-up time was 21.6 months. The VAS scores of both group de- creased obviously（ P 〈0.01）. In the early postoperative stage, both groups showed good restoration of the vertebral height, and no significant difference was found（ P 〉0.05）. But last follow-up survey showed that the vertebral height in the PVP group decreased significantly, 3 patients got fracture for the second time in the injured vertebra and 5 patients got fracture in the adjacent segment. No fractures reoccurred and more cases of joint space narrowing were found in Group Two（ P 〈0.01）. Conclusion The combined use of PVP and therapy of using PPS can produce good curative effect on OVCF by reducing the recurrence of fractures in the injured vertebra and the adjacent segments, while using PPS alone may accelerate the degeneration of adjacent segments.