经皮椎弓根螺钉结合椎体成形术治疗骨质疏松性胸腰段骨折

Effect observation of percutaneous pedicle screw fixation combined with percutaneous vertebroplasty for the treatment of osteoporotic thoracolumbar fractures

目的 :探讨经皮椎弓根螺钉固定(PPSF)结合伤椎骨水泥强化治疗胸腰段骨质疏松性椎体压缩性骨折(OVCF)的临床疗效。方法 :对2014年1月至2015年12月收治的94例胸腰段OVCF患者进行回顾性分析,其中男31例,女63例;年龄65~70岁,平均67.2岁;T_(11)15例,T_(12)32例,L_129例,L_218例。根据治疗方法分为PPSF结合PVP治疗组(A组,43例),PVP治疗组(B组,51例)。记录两组手术时间、术中出血量、伤椎骨水泥用量、术后卧床时间,比较两组术前,术后3 d、1年伤椎前缘高度百分比、矢状面Cobb角及视觉模拟评分(VAS),并观察两组术后并发症情况。结果:94例患者均获随访,时间12~24个月,平均18.5个月。手术时间A组为(96.2±28.7)min,B组为(31.8±10.6)min;术中出血量A组为(62.2±25.5)ml,B组为(25.4±10.9)ml;伤椎骨水泥用量A组为(5.5±0.5)ml,B组为(4.9±1.1)ml;术后卧床时间A组为(5.1±1.8)d,B组为(1.8±0.7)d。A组较B组手术时间更长,术中出血量更多,伤椎骨水泥用量更大,术后卧床时间更长(P<0.05)。两组患者术后3 d及1年伤椎高度百分比、Cobb角均较术前明显恢复。末次随访时,伤椎前缘高度百分比、Cobb角A组[(85.6±3.5)%和(11.9±5.3)°]均优于B组[(84.2±4.5)%和(15.3±3.4)°](P<0.05)。B组出现3例伤椎再次骨折塌陷的情况。两组患者术后3 d、1年VAS均较术前明显降低,两组差异无统计学意义(P>0.05)。结论:采用PPSF结合PVP较单纯采用PVP治疗胸腰段OVCF,能获得较强的椎体强度和刚度,更有利于改善伤椎的复位效果,维持伤椎高度,防止椎体塌陷。

Objective：To evaluate the clinical effects of percutaneous pedicle screw fixation（PPSF） combined with percutaneous vertebroplasty（PVP） for the treatment of osteoporotic thoracolumbar fractures. Methods：The clinical data of 94 patients with osteoporotic thoracolumbar fractures treated from January 2014 to December 2015 were retrospectively analyzed.There were 31 males and 63 females,aged from 65 to 70 years old with an average of 67.2 years. Fracture level was T_（11） on 15 cases,T_（12） on 32 cases,L_1 on 29 cases and L_2 on 18 cases. The patients were divided into two groups according to different therapeutic methods. Percutaneous pedicle screw fixation combined with percutaneous vertebroplasty were applied in 43 patients（group A） and percutaneous vertebroplasty was applied to 51 patients（group B）. Operation time,intraoperative blood loss,bone cement volume,postoperative in bed time were recorded; preoperatively,3 d,1 year after the operation,the ratios of anterior border heights,sagittal Cobb angles,visual analogue scale（VAS） scores were compared between two groups. The condition of postoperative complication in two groups was analyzed. Results：All the patients were followed up for 12 to 24 months with an average of 18.5 months. Operation time of group A [（96.2±28.7） min] was longer than that of group B [（31.8±10.6）min]. Intraoperative blood loss of group A [（62.2±25.5） ml] was more than that of group B [（25.4±10.9） ml]. Bone cement volume of group A [（5.5±0.5） ml] was larger than that of group B [（4.9±1.1） ml]. Postoperative in bed time of group A[（5.1±1.8） d] was longer than that of group B [（1.8 ±0.7） d]. There were significant differences in operation time,intraoperative blood loss,bone cement volume,postoperative in bed time between two groups（P〈0.05）. Three days,12 months after the operation,the ratios of anterior border heights and Cobb angles in two groups were significantly improved. At final follow up,the ratio of anterior border height and Cobb angle of group A [（85.6 ±3.5）%,（11.9 ±5.3）° ]were better than of group B [（84.2 ±4.5）%,（15.3±3.4）° ]（P〈0.05）. Three cases in group B had re collapse of cemented vertebral bodies. Postoperative at 3 d,1 year,VAS score of all patients had significantly decreased（P〈0.05）,and there was no significant difference between two groups（P〈0.05）.Conclusion：Compared to simple PVP,PPSF combined with PVP in treating osteoporotic thoracolumbar fracture can obtain stronger vertebral strength and stiffness,furthermore to improve vertebral reduced effect,keeping vertebral heights,and preventing vertebral re collapse.