椎弓根螺钉强化内固定术与骨填充网袋椎体成形术治疗稳定型骨质疏松胸腰椎爆裂骨折的比较研究

Bone cement-augmented pedicle screw fixation versus bone filling vertebroplasty for stable osteoporotic thoracolumbar burst fracture

目的比较椎弓根螺钉强化内固定术与骨填充网袋椎体成形术治疗稳定型骨质疏松胸腰椎爆裂骨折(TBF)的疗效。方法回顾性研究2014年8月至2017年8月重庆医科大学附属第一医院骨科收治的48例不伴神经症状稳定型骨质疏松TBF患者资料,根据手术方式不同将患者分为椎弓根螺钉强化内固定术组(A组,27例)和骨填充网袋椎体成形术组(B组,21例)。通过比较两组患者术前、术后视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、伤椎前缘高度及局部后凸cobb角观察疗效。比较两组患者手术时间、骨水泥使用量、术中出血量、住院天数及相关医疗花费。结果两组患者临床基线比较差异均无统计学意义(P>0.05),具有可比性。术后3 d B组患者VAS评分[(2.8±1.0)分]、ODI[(26.0±3.5)分]较A组[(4.6±1.3)分、(34.3±2.9)分]低,差异均有统计学意义(P< 0.05)。A组患者术后3个月和末次随访时患者的VAS评分[(2.9±0.9)分和(2.3±0.7)分]、ODI[(24.7±3.1)分和(23.1±4.6)分]均较术后3 d[(4.6±1.3)分、(34.3±2.9)分]降低,差异有统计学意义(P<0.05)。B组患者术后3个月和末次随访时患者的VAS评分[(2.8±0.9)分和(2.3±1.0)分]、ODI[(23.8±3.7)分和(22.8±5.6)分]与术后3 d[(2.8±1.0)分、(26.0±3.5)分]比较,差异均无统计学意义(P<0.05)。B组患者术后3 d、术后3个月、末次随访时伤椎前缘高度(81.1%±3.7%、81.1%±3.4%、75.6%±5.8%)均小于A组(91.4%±4.4%、90.1%±2.9%、83.5%±4.4%),cobb角(17.0°±4.0°、18.0°±3.5°、22.1°±3.6°)均大于A组(14.0°±3.2°、14.3°±5.5°、19.2°±3.2°),所有患者末次随访时的伤椎前缘高度、后凸cobb角均较术后3 d和3个月改善,差异有统计学意义(P<0.05)。B组患者手术时间[(51.5±7.3)min]、术中出血量[(16.0±8.2)mL]、住院天数[(3.4±0.9)d]和人均住院费用[(3.4±0.4)万元]均少于A组[(91.5±9.8)min、(77.4±16.5)mL、(8.7±2.2)d、(5.5±0.9)万元],术中骨水泥用量[(5.1±0.7)mL]较A组[(1.9±0.7)mL]增加,差异均有统计学意义(P<0.05)。结论对于稳定型骨质疏松TBF患者,椎弓根螺钉强化内固定术与骨填充网袋椎体成形术疗效相当,但后者创伤小、恢复快、医疗花费较少。

Objective To compare the clinical efficacy between bone cement-augmented pedicle screw fixation and bone filling vertebroplasty for stable osteoporotic thoracolumbar burst fracture (TBF). Methods From August 2014 to August 2017, 48 patients with stable osteoporotic TBF but no neurological symptoms were treated at Department of Orthopedics, The First Affiliated Hospital to Chongqing Medical University. Those undergoing bone cement-augmented pedicle screw fixation were assigned into Group A while those undergoing bone filling vertebroplasty into Group B. The clinical efficacy was evaluated by comparing visual analogue scale (VAS) for pain assessment, Oswestry disability index (ODI), compression ratio of an- terior vertebral height, and cobb kyphotic angle between preoperation and postoperation. The 2 groups were compared in terms of operation time, bone cement consumption, blood loss, hospital stay and relative medical costs. Results Of the 48 patients included in this study, 27 were in Group A and 21 in Group B. The 2 groups were comparable as their baseline characteristics were insignificantly different (P>0.05). At 3 days after operation, the VAS (2.8±1.0) and ODI (26.0±3.5) scores for group B were significantly lower than those for group A (4.6±1.3 and 34.3±2.9)(P<0.05). In group A at 3 months after operation and final follow-up, the VAS (2.9±0.9 and 2.3±0.7) and ODI (24.7±3.1 and 23.1±4.6) scores were significantly lower than those at 3 days after operation (4.6±1.3 and 34.3±2.9)(P<0.05). In group B at 3 months after operation and final follow-up, the VAS (2.8±0.9 and 2.3±1.0) and ODI (23.8±3.7 and 22.8±5.6) scores were insignificantly better than those at 3 days after operation (2.8±1.0 and 26.0±3.5)(P>0.05). At 3 days and 3 months after operation and final follow-up, group B had significantly smaller compression ratios of anterior vertebral height (81.1%±3.7%, 81.1%±3.4% and 75.6%±5.8%) than group A did (91.4%±4.4%, 90.1%±2.9% and 83.5%±4.4%) but significantly larger cobb kyphotic angles (17.0°±4.0°, 18.0°±3.5° and 22.1°±3.6°) than group A (14.0°±3.2°, 14.3°±5.5° and 19.2°±3.2°)(P<0.05). The compression ratio of anterior vertebral height and cobb kyphotic angle at the final follow-up in all the patients were significantly improved compared with those at 3 days and 3 months after operation (P<0.05). Group B had significantly less operation time (51.5±7.3 min), blood loss (16.0±8.2 mL), hospital stay (3.4±0.9 d) and medical costs per person (34,000±4,000 RMB yuan) than group A (91.5±9.8 min, 77.4±16.5 mL, 8.7±2.2 d and 55,000±9,000 RMB yuan), but significantly larger bone cement consumption (5.1±0.7 mL) than group A (1.9±0.7 mL)(P<0.05). Conclusion For patients with stable osteoporotic TBF, both bone cement-augmented pedicle screw fixation and bone filling vertebroplasty can lead to similar clinical outcomes, but the latter may have advantages of less invasion, faster recovery and lower medical costs.