微创经皮椎弓根钉联合骨水泥注入治疗老年骨质疏松性椎体骨折临床观察

Clinical observation on minimally invasive percutaneous pedicle screw combined with bone cement injection in the treatment of senile osteoporotic vertebral fracture

目的探究经皮椎体后凸成形术（PKP）、微创经皮椎弓根钉内固定术联合骨水泥注入对老年骨质疏松性椎体骨折的临床疗效。方法选取64例经手术治疗的因骨质疏松导致的椎体压缩性骨折患者，随机分为观察组和对照组，每组32例。对照组行PKP，观察组行经皮椎弓根钉联合骨水泥注入。比较两组手术时间、出血量和术后住院天数。观察并记录术前，术后1 d，术后1周，术后1、2、3、6个月及末次随访时两组VAS评分、骨水泥渗漏情况，计算并比较两组不同时期椎体高度压缩率、恢复率、Cobb角、后凸矫正率。结果术后平均随访17.7个月，对照组椎间隙骨水泥渗漏1例，观察组未发现骨水泥渗漏。观察组患者手术时间、出血量及术后住院天数均多于对照组，差异有统计学意义（P〈0.05）。对照组和观察组术前VAS评分分别为（9.4±3.1）、（9.4±2.0）分，术后1 d降至（2.0±1.3）、（2.3±1.1）分（P〈0.01）；两组术前Oswestry评分为别为（37.2±10.1）、（36.8±9.7）分，术后下降至（11.0±9.1）、（10.7±10.1）分（P〈0.01）。两组术后椎体高度压缩率、Cobb角均低于术前（P均〈0.01）。对照组VAS评分于术后1周升高，至术后2个月短暂下降后趋于稳定；对照组伤椎高度压缩率、Cobb角度术后持续增高，伤椎高度恢复率、后凸矫正率术后持续降低，均至术后3个月趋于稳定。观察组各指标随术后时间延长无明显变化，且在各时间点与对照组比较差异均有统计学意义（P均〈0.05）。结论与PKP比较，微创经皮椎弓根钉联合骨水泥注入治疗老年骨质疏松性椎体骨折临床疗效显著，可有效预防术后椎体塌陷，维持治疗效果。

Objective To investigate the clinical effect of percutaneous kyphoplasty （PKP）, minimally invasive percutaneous pedicle screw fixation combined with bone cement injection in the treatment of senile osteoporotic vertebral fracture.Methods Sixty-four patients who underwent operation with osteoporotic vertebral compression fractures due to osteoporosis were randomly divided into control group and observation group, with 32 cases in each group. The control group underwent PKP, the observation group underwent percutaneous pedicle screw fixation combined with bone cement injection. Operation time, intraoperative blood loss and hospital stay after operation were compared between two groups. VAS score and bone cement leakage were observed and recorded before operation, on 1 d, in 1 week, 1, 2, 3, 6 months after operation and at the last follow-up. Correction rate, recovery rate, vertebral compression rate, Cobb angle and kyphosis correction rate in different periods were compared.Results The average follow-up period was 17.7 months, and the first case of bone cement leakage were found in control group. There was no leakage of bone cement in observation group. The operation time, blood loss and postoperative hospital stay in observation group were more than those in control groups, the difference was significant （P〈0.01）. VAS score of control group and observation group decreased from 9.4±3.1, 9.4±2.0 before operation to 2.0±1.3, 2.3±1.1, 1 d after operation respectively （P〈0.05）; Oswestry score of control group and observation group decreased from 37.2±10.1, 36.8±9.7 before operation to 11.0±9.1, 10.7±10.1 after operation respectively （P〈0.01）. Vertebral compression rate and Cobb angle significantly decreased in both groups after operation （P all〈0.01）. The VAS scores of control groups increased 1 week after operation, and had transient decrease 2 months after operation and then tended to be stable; in control group, vertebral height compression rate and Cobb angle increased continuously after operation, recovery rate of injured vertebral height and kyphosis correction rate after operation reduced and then tended to be stable 3 months after operation. The indexes of observation groups had no significant change with the time going after operation, and there were significant differences in the indexes at each point between the two groups （P〈0.05）.Conclusions Minimally invasive percutaneous pedicle screws combined with the bone cement injection, compared with PKP, has significant effect on senile osteoporotic vertebral fractures and can prevent further vertebral collapse so as to maintain the curative effect.