有限切开经椎弓根椎体后凸成形术治疗中段胸椎骨质疏松性压缩骨折的疗效及可行性分析

Efficacy and feasibility of transpedicular kyphoplasty with limited incision in the treatment of middle thoracic osteoporotic vertebral compression fractures

目的探讨有限切开经椎弓根椎体后凸成形术治疗中段胸椎骨质疏松性压缩骨折(osteoporosis vertebral compression fracture,OVCF)的疗效。方法纳入2014年4月~2016年4月收治的64例中段胸椎OVCF患者,将采用有限切开经椎弓根椎体后凸成形术治疗的30例患者设为观察组,经皮球囊扩张椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗的34例设为对照组,均随访2年,比较两组手术情况和临床疗效。结果观察组手术出血量显著高于对照组,手术时间及术中透视次数、穿刺时间显著低于对照组,一次穿刺成功率显著高于对照组,差异有统计学意义(P<0.05);两组术后1个月、6个月、2年的VAS评分较术前均显著降低,椎体高度显著升高(P<0.05),组间各项指标的差异均无统计学意义(P>0.05);两组并发症发生率均无统计学意义(P>0.05)。结论有限切开经椎弓根椎体后凸成形术治疗中段胸椎OVCF能获得与PKP术一致的近期疗效,且手术时间短、透视次数少、穿刺成功率高。

Objective To investigate the efficacy and feasibility of transpedicular kyphoplasty with limited incision in the treatment of middle thoracic osteoporosis vertebral compression fracture (OVCF). Methods From April 2014 to April 2016, 64 cases of middle thoracic OVCF treated in our hospital were selected and divided into two groups according to the different surgical Methods . The observation group (n=30) received the transpedicular kyphoplasty with limited incision, while the control group (n=34) received the percutaneous kyphoplasty (PKP). The clinical data of all patients were retrospectively analyzed. The surgical related indicators, visual analogue scale (VAS) score and vertebral height were recorded. The incidence rate of the complications was also recorded during the post-operative 2-year follow-up. Results The observation group had higher intraoperative blood loss and one-time puncture success rate, shorter operation time and puncture time, as well as lower X-ray fluoroscopy frequency than those of the control group ( P <0.05). The scores of VAS along with the vertical height had no difference before surgery ( P >0.05). At postoperative 1 month, 6 months and 2 years, the scores of VAS were decreased, meanwhile, the vertical height was increased, with significant differences within groups ( P <0.05), while the differences between the two groups were not significant ( P >0.05). The incidence rate of the complications had no significant difference between the two groups ( P >0.05). Conclusion The short-term efficacy of transpedicular kyphoplasty with limited incision and PKP for patients with middle thoracic OVCF is similar, while the former method has advantages of shorter operation time, less X-ray fluoroscopy frequency and higher puncture success rate.