经皮椎体成形术联合骨水泥强化经皮椎弓根螺钉固定对严重骨质疏松性胸腰椎压缩性骨折的疗效

The efficacy comparison between posterior kyphoplasty and posterior vertebroplasty combined with bone cement-enhanced percutaneous pedicle screw fixation on the treatment of severe osteoporotic vertebra compression fracture

目的比较经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)与经皮椎体成形术(percutaneous vertebroplasty,PVP)联合骨水泥强化经皮椎弓根螺钉固定(percutaneous pedicle screw fixation,PPSF)治疗严重骨质疏松性胸腰椎压缩性骨折(osteoporotic vertebral compression fracture,OVCF)的围术期临床指标、解剖学指标及术后并发症。方法选取121例严重OVCF患者为研究对象,用随机数字表法分为A、B两组。A组(59例)行PKP术治疗,B组(62例)行PVP联合骨水泥强化PPSF术治疗。比较两组围手术期相关临床指标;术前、术后7 d、末次随访时疼痛视觉模拟评分(visual analogue scale,VAS)评分;伤椎前缘高度比、后凸Cobb角;术后7 d、末次随访时的Oswestry功能障碍指数问卷表评分(ODI)及JOA评分;术后并发症情况。结果A组手术时间、术中出血量、术中透视次数、首次下床活动时间及住院时间均优于B组,差异有统计学意义(P<0.05)。术前及末次随访时,两组VAS评分比较,差异有统计学意义(P>0.05);但术后7 d,B组VAS评分低于A组,差异有统计学意义(P<0.05)。术后7 d及末次随访时,两组ODI评分比较,差异均无统计学意义(P>0.05)。术后,两组伤椎前缘高度比及后凸Cobb角较术前均改善,差异有统计学意义(P<0.05);组间比较,B组优于A组,差异有统计学意义(P<0.05)。术后7 d,两组JOA评分比较,差异均无统计学意义(P>0.05);但末次随访时,A组评分高于B组,差异有统计学意义(P<0.05)。两组术后并发症发生率比较,差异无统计学意义(P>0.05)。结论PKP术治疗严重OVCF创伤小、操作简便、术后康复快。而PVP联合骨水泥强化PPSF术在早期缓解疼痛、恢复椎体高度、矫正后凸畸形方面优于PKP术。

Objective To compare the efficacies between posterior kyphoplasty(PKP)and posterior vertebroplasty(PVP)combined with bone cement-enhanced percutaneous pedicle screw fixation(PPSF)on the treatment of severe osteoporotic vertebra compression fracture(OVCF).Methods A total of 121 patients with severe OVCF who were admitted from February 2017 to February 2018,and randomly divided into two groups.Group A(n=59)received PKP and Group B(n=62)received PVP combined with bone cement-enhanced PPSF.The perioperative related indicators,including VAS score,ODI score,anterior vertebral height compression ratio,and kyphosis Cobb angle,JOA score,and postoperative complications were compared.Results The operation time,intraoperative blood loss,intraoperative fluoroscopy,time of getting out of bed and hospital stay in Group A were significantly better than those in Group B(P<0.05).At preoperative and last follow-up,there were no significant difference in VAS scores between the two groups(P>0.05).Seven days after operation,the VAS score in Group B was significantly lower than that in Group A(P<0.05).There was no significant difference in ODI score between the two groups 7 days after operation or at the last follow-up(P>0.05).After surgery,the anterior vertebral height ratio and kyphosis Cobb angle were significantly improved in both groups(P<0.05),and they were significantly more prominent in Group B than Group A(P<0.05).Seven days after operation,there was no significant difference in JOA score between the two groups(P>0.05);and at the last follow-up,the JOA score of Group A was significantly higher than that in Group B(P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).Conclusion PKP is a simple and effective method for the treatment of severe OVCF.However,PVP combined with bone cement-enhanced PPSF is better than PKP in relieving pain,restoring vertebral height and correcting kyphosis.