经皮椎体后凸成型术与椎弓根螺钉系统治疗胸腰段椎体压缩性骨折的临床疗效比较

Comparison of Percutaneous Kyphoplasty and Pedicle Screw System in the Treatment of Thoracolumbar Vertebral Compression Fractures

目的探讨经皮椎体后凸成型术与椎弓根螺钉系统治疗胸腰段椎体压缩性骨折的临床疗效比较。方法方便选取该院2016年2月—2018年4月收治的胸腰段椎体压缩性骨折患者100例,随机分组。椎弓根螺钉系统固定组实施椎弓根螺钉系统固定,经皮椎体后凸成型术组实施经皮椎体后凸成型术。分析腰椎功能评分值、生活自理能力、视觉模拟评分、椎体前缘丢失高度以及COBB角;术中平均出血量、下床活动以及手术操作平均时间和并发症。结果治疗后腰椎功能评分值、生活自理能力、椎体前缘丢失高度、视觉模拟评分以及COBB角(87.24±4.23)分、(93.21±3.21)分、(4.21±1.23)mm、(1.21±0.21)分、(11.15±1.16)°优于椎弓根螺钉系统固定组(67.24±4.21)分、(80.46±3.67)分、(7.56±1.46)mm、(2.11±0.65)分、(17.56±2.21)°,差异有统计学意义(t=6.924、7.823、6.912、5.824、6.813,P<0.05)。经皮椎体后凸成型术组术中平均出血量、下床活动以及手术操作平均时间(164.02±12.12)mL、(2.02±0.12)d、(62.67±6.21)min优于椎弓根螺钉系统固定组(253.14±20.24)mL、(4.14±2.24)d、(73.15±11.01)min,差异有统计学意义(t=5.267、5.123、6.312,P<0.05)。经皮椎体后凸成型术组并发症低于椎弓根螺钉系统固定组,差异有统计学意义(χ^2=6.933,P<0.05),经皮椎体后凸成型术组并发症中,发生2例感染,发生率是4%。椎弓根螺钉系统固定组并发症中,有4例高度丢失,6例内固定失败,总发生10例,发生率是20%。结论胸腰段椎体压缩性骨折患者实施经皮椎体后凸成型术可获得较好效果,其出血较少,手术时间较短,术后康复快,可更好缓解疼痛和改善腰椎功能,促进患者脊柱角度的纠正和伤椎椎体高度的恢复,减少并发症发生,改善患者生活自理能力。

Objective To evaluate the clinical efficacy of percutaneous kyphoplasty and pedicle screw system in the treatment of thoracolumbar vertebral compression fractures.Methods A total of convenient selection 100 patients with thoracolumbar vertebral compression fractures from February 2016 to April 2018 were enrolled admittded in the study.The pedicle screw system fixation group was treated with pedicle screw system fixation,and the percutaneous kyphoplasty group was performed with percutaneous kyphoplasty.Lumbar function score,life self-care ability,visual analog score,vertebral body leading height loss and COBB angle;mean intraoperative blood loss,get out of bed and average time of operation;complications.Results After treatment,lumbar function score,life self-care ability,height loss of vertebral body leading edge,visual analog score and COBB angle(87.24±4.23)point、(93.21±3.21)point、(4.21±1.23)mm、(1.21±0.21)point、(11.15±1.16)°were better than pedicle screws system fixation group of(67.24±4.21)point、(80.46±3.67)point、(7.56±1.46)mm、(2.11±0.65)point、(17.56±2.21)°.The difference was statistically significant(t=6.924,7.823,6.912,5.824,6.813,P<0.05).The mean bleeding volume,get out of bed,and average operation time of the percutaneous kyphoplasty group were(164.02±12.12)mL、(2.02±0.12)d、(62.67±6.21)min which was better than the pedicle screw system fixation group(253.14±20.24)mL、(4.14±2.24)d、(73.15±11.01)min,the difference was statistically significant(t=5.267,5.123,6.312,P<0.05).The complication of percutaneous kyphoplasty was lower than that of pedicle screw fixation group,the difference was statistically significant(χ^2=6.933,P<0.05).In the complication of percutaneous kyphoplasty group,2 cases of infection occurred,the incidence rate was 4%.Among the complications of the pedicle screw system fixation group,4 cases were highly lost,6 cases failed internal fixation,and 10 cases occurred in total,the incidence rate was 20%.Conclusion Percutaneous kyphoplasty can achieve better results in patients with thoracolumbar vertebral compression fractures.It has less bleeding,shorter operation time,faster postoperative recovery,better pain relief and improved lumbar function.It can promote the correction of the patient's spinal angle and the recovery of the injured vertebral body height,reduce the occurrence of complications,and improve the patient's self-care ability.