三种术式治疗胸腰椎骨质疏松性骨折后凸畸形

Comparison of three surgical procedures for thoracolumbar osteoporotic fractures with kyphosis

[目的]比较PVP、PKP和PSO治疗胸腰椎骨质疏松性骨折伴后凸畸形的临床疗效。[方法] 2016年5月~2018年12月于本院手术诊治的胸腰椎骨质疏松性骨折伴后凸畸形患者105例。根据手术方式将患者分为三组,PVP组34例,PKP组46例,PSO组25例,比较三组患者围手术期、随访和影像资料。[结果] 105例患者均顺利完成手术。三组中PSO组患者手术时间和住院时间最长,术中失血量最多(P<0.05)。随时间推移,三组患者VAS和ODI评分均显著减少(P<0.05)。术前三组患者的VAS和ODI评分差异均无统计学意义(P>0.05);术后各时间点VAS和ODI评分从小至大依次为PSO组<PKP组<PVP组,其中术后6个月和末次随访时,三组间ODI评分差异有统计学意义(P<0.05)。影像方面,三组患者术后局部后凸Cobb角均较术前显著减少(P<0.05);术后各时间点Cobb角从小至大依次为PSO组<PKP组<PVP组,差异均有统计学意义(P<0.05)。[结论] PSO治疗胸腰椎骨质疏松性骨折伴后凸畸形效果最佳,建议优先选择,而一般情况较差的患者可选择PKP。

[Objective] To compare the clinical outcomes of percutaneous vertebroplasty(PVP), percutaneous kyphoplasty(PKP) and pedicle subtraction osteotomy(PSO) for thoracolumbar osteoporotic fractures accompanied with kyphosis. [Methods]From May 2016 to December 2018, 105 patients received surgical treatment for thoracolumbar osteoporotic fractures with kyphosis in our hospital. In term of surgical procedure conducted, 34 patients had PVP, while 46 patients underwent PKP and the remaining 25 patients received PSO. The perioperative, follow-up and radiographic documents were compared among the 3 groups. [Results] All the 105 patients had operation performed smoothly, whereas the PSO group consumed the longest operation time, associated with the most intraoperative blood loss and the longest hospital stay among the 3 groups(P<0.05). The VAS and ODI scores were not statistical different among the 3 groups before operation, and significantly decreased over time in all the 3 groups(P<0.05). At each time point after operation, the VAS and ODI scores ranked down-up in a sequence of the PSO group < the PKP group <the PVP group, which proved statistically significant in ODI score among them at 6 months after operation and the latest follow-up(P<0.05). With regard to imaging assessment, the local kyphotic Cobb’s angle significantly decreased in all the 3 groups postoperatively compared with those before operation(P<0.05), and arranged down-up in a sequence of the PSO group < the PKP group < the PVP group with statistical significances at all time points postoperatively(P<0.05). [Conclusion] The PSO achieves the best clinical outcomes in this study, therefore, should be the first choice for thoracolumbar osteoporotic fractures accompanied with kyphosis. If the patients cannot endurance PSO, the PKP is the alternative.