不同微创手术方法治疗中老年胸腰椎爆裂性骨折A3.1型疗效比较

Comparison of clinical effect of different minimally invasive surgeries in treatment of type A3.1 thoracolumbar burst fractures of aged patients

目的探讨比较不同微创手术方法治疗中老年胸腰椎爆裂性骨折A3.1型的临床效果。方法2014年3月—2016年3月期间在上海市同仁医院进行诊断治疗的中老年胸腰椎骨折且符合手术条件的患者45例,其中男性18例,女性27例;年龄50~65岁,平均58.6岁。受伤原因:跌倒伤38例,道路交通伤7例。按手术方法不同分为经皮椎体成形术治疗组(PVP组)、经皮椎弓根螺钉内固定术治疗组(PPSF组)和经皮椎弓根螺钉内固定术结合椎体成形术治疗组(PVP+PPSF组),每组15例。观察3组患者平均手术时间、出血量、住院时间,比较术后Cobb角及椎管占位率以及VAS评分。结果 PVP组、PPSF组、PVP+PPSF组平均手术时间分别为(31.5±6.4)、(62.2±10.6)、(66.5±8.5)min;平均出血量分别为(5.6±2.4)、(52.4±8.3)、(42.6±7.2)m L;平均住院时间分别为(3.2±0.9)、(10.8±1.6)、(9.8±1.7)d。PVP组平均手术时间、出血量、住院时间均短于其他两组。三组术后Cobb角、椎管占位率以及VAS评分均较术前明显改善。其中PVP组术后Cobb角及椎管占位率改善低于PPS组和PVP+PPSF组。PVP组和PVP+PPSF组术后1周VAS评分优于PPSF组,但1年后3组VAS评分差异无统计学意义(P>0.05)。结论 PVP术中出血量少,手术时间短,住院时间短。PPSF术创口小,脊柱减压效果好,而PPSF+PVP术同时具备PVP术和PPSF优点,且避免了PVP术和PPSF缺点,可能更适合于中老年胸腰椎爆裂性骨折A3.1型。

Objective To explore the clinical effect of different minimally invasive surgeries in treatment of type A3. 1 thoracolumbar burst fractures of aged patients. Methods Forty-five thoracolumbar fractures patients（ 18 males and 27 females with an average age of 58. 6（ 50-65） years） meeting the operation conditions in our hospital from Mar. 2014 to Mar. 2016 were selected and randomly divided into three groups with 15 cases in each group.Thirty eight were injured from falling,and 7 were from traffic auidents. The treatment group A were treated with PVP（ percutaneous vertebroplasty）,the treatment group B were treated with PPSF（ percutaneous pedicle screw fixation）,and the treatment group C were treated with PVP ＋ PPSF. Various parameters of the three groups were observed and the curative effect was evaluated and the comparison of different methods was analyzed. Results The average operation time of A,B and C group was（ 31. 5 ± 6. 4）,（ 62. 2 ± 10. 6）,（ 66. 5 ± 8. 5） minutes,respectively.The average blood loss of A,B and C group was（ 5. 6 ± 2. 4）,（ 52. 4 ± 8. 3）,（ 42. 6 ± 7. 2） m L,respectively. The average hospital stay of A,B and C group was（ 3. 2 ± 0. 9）,（ 10. 8 ± 1. 6）,（ 9. 8 ± 1. 7） days,respectively. The average operation time,blood loss,and hospital stay in the treatment group A was the shortest among three groups. The postoperative Cobb angle,spinal canal encroachment and VAS score of three groups were significantly improved than those of pre-operation. The improvements of Cobb angle and spinal canal encroachment in group A were lower than those in group B and C. The VAS score of group A and group C were better than group B,but after 1 year the VAS score had no statistical significance（ P 0. 05）. Conclusion PVP has advantages of little blood loss,short operation time and hospital stay. PPSF has small incision and better decompression of spinal canal encroachment. PPSF＋ PVP operation not only has both advantages but also can avoid disadvantages of two groups. So PPSF ＋ PVP is suitable operation for type A3. 1 thoracolumbar burst fractures of aged patients.