三种术式治疗无神经症状骨质疏松性胸腰椎爆裂骨折的疗效比较

Clinical efficacy of three operative methods in the treatment of osteoporotic thoracolumbar burst fractures without neurological symptoms

目的比较经皮球囊扩张椎体后凸成形术(percutaneous kyphoplasty,PKP)、微创经皮复位内固定术、切开复位植骨融合内固定术三种术式治疗无神经症状骨质疏松性胸腰椎爆裂骨折的临床疗效。方法回顾性分析2015年6月至2017年6月我院收治的99例无神经症状骨质疏松性单节段胸腰椎爆裂骨折病人,根据手术方式分为PKP组(40例)、经皮复位组(27例)和切开复位组(32例)。收集各组病人的手术时间、出血量、住院时间、疼痛视觉模拟量表(visual analogue scale,VAS)评分、伤椎Cobb角及相关并发症;以随访X线片评价骨折复位情况。结果PKP组的手术时间、出血量、住院时间分别为(0.7±0.1)h、(4.6±1.6)ml、(2.4±0.9)d,均显著低于其他两组,且经皮复位组的出血量、住院时间显著低于切开复位组,差异均有统计学意义(P均<0.05)。三组病人术后、术后3个月和末次随访时的VAS评分和Cobb角均较术前显著改善,PKP组术后、术后3个月和末次随访时的Cobb角显著高于其他两组,差异均有统计学意义(P均<0.05)。PKP组术后骨水泥渗漏9例,无需处理。经皮复位组1例术后皮下血肿,处理后伤口愈合良好;2例术后钉道松动,无症状,术后1年取出。切开复位组术后病人伤口延迟愈合5例,处理后伤口延迟愈合。结论治疗无神经症状骨质疏松性胸腰椎爆裂骨折,这三种术式均可安全、有效缓解病人腰背部疼痛症状,但各有优缺点,临床应用还需根据病人诉求结合具体情况选择合适的治疗方案。

Objective To comparatively evaluate the clinical efficacy of percutanous kyphoplasty(PKP),percutaneous internal fixation or open reduction internal fixation and bone graft fusion in patients with osteoporotic thoracolumbar burst fractures without neurological symptoms.Methods A retrospective study was performed on 99 patients with single-level osteoporotic thoracolumbar burst fractures without neurological symptoms admitted between June 2015 and June 2017,and the patients were divided into PKP group(40 cases),percutaneous internal fixation group(27 cases)and open reduction internal fixation group(32 cases)according to the surgical approaches.The operation time,bleeding volume,hospitalization time,visual analogue scale(VAS)score,Cobb angle of injured vertebrae and related complications were collected in each group.Xray examination was done to evaluate fracture reduction.Results The operation time,bleeding volume,and hospital stay in the PKP group were(0.7±0.1)h,(4.6±1.6)ml,and(2.4±0.9)days,which were significantly reduced as compared with those in the rest two groups,and the bleeding volume and hospital stay in the percutaneous reduction group were significantly reduced as compared with those in the open reduction group.The differences were statistically significant(all P<0.05).The VAS score and Cobb angle in the three groups after surgery,3 months after surgery and at the last follow-up were significantly improved as compared with those before surgery.The Cobb angle in the PKP group after operation,3 months after operation and at the last follow-up was significantly larger than that in the rest two groups,and the differences were statistically significant(all P<0.05).There were 9 cases of postoperative cement leakage without treatment in PKP group.In percutaneous internal fixation group,1 case had subcutaneous hematoma,and the wound healed well after treatment,and 2 cases had fixation loosening but no symptoms,and internal fixation was taken out one year after operation.In open reduction internal fixation group,delayed wound healing occurred in 5 patients and delayed healing was obtained after treatment.Conclusion Three surgical treatments for osteoporotic thoracolumbar burst fractures without neurological symptoms provided safe and satisfactory results.However,each of the three methods has its own advantages and disadvantages.The most appropriate treatment should be selected according to the patients.demands and conditions.