不同手术方式治疗胸腰椎骨质疏松性骨折伴后凸畸形的临床疗效对比

Comparison of Clinical Effects of Different Surgical Methods in the Treatment of Thoracolumbar Osteoporotic Fracture with Kyphosis

目的比较不同手术方式治疗胸腰椎骨质疏松性骨折伴后凸畸形的临床疗效。方法回顾分析2017年5月至2019年5月收治的105例胸腰椎骨质疏松性骨折伴后凸畸形,行经皮椎体成形术(Percutaneous vertebroplasty,PVP)或经皮椎体后凸成形术(Percutaneous kyphoplasty,PKP)的患者。其中,PVP组44例、PKP组61例。于术前和术后1 d、3个月和末次随访时评估患者Cobb角、ODI指数、伤椎前缘高度和VAS评分,并记录手术时间、术中出血量、住院时间、骨水泥注射量、术后骨水泥渗漏和再发骨折例数。结果术后两组患者各时间点Cobb角、ODI指数和VAS评分均较术前明显改善(P<0.05),PKP组术后各时间点Cobb角和ODI指数均低于PVP组(P<0.05),伤椎前缘高度高于PVP组(P<0.05),术后1 d时的VAS评分低于PVP组(P<0.05),术后3个月及末次随访时两组的VAS评分差异无统计学意义(P>0.05)。两组患者手术时间、住院时间、术中失血量及骨水泥注射量比较无统计学差异(P>0.05)。PVP组骨水泥渗漏发生率及继发性椎体骨折发生率均明显高于PKP组(P<0.05)。结论PKP组患者Cobb's角、ODI指数、伤椎前缘高度和VAS评分改善情况均优于PVP组,且未增加手术创伤和风险。

Objective To compare the clinical effects of different surgical methods in the treatment of thoracolumbar osteoporotic fracture with kyphosis.Methods A retrospective analysis was performed on 105 patients of thoracolumbar osteoporotic fractures with kyphosis who underwent PVP or PKP surgery from May 2017 to May 2019.The patients were divided into two groups according to the mode of operation:PVP group(n=44)and PKP group(n=61).The Cobb's angle,ODI index,anterior edge height of injured vertebrae and VAS score were evaluated before operation,1 day after operation,3 months after operation and at the last follow-up.The operation time,intraoperative blood loss,hospitalization time,bone cement injection volume,postoperative bone cement leakage and recurrent fracture cases were recorded.Results The Cobb's angle,ODI index and VAS score in both groups were significantly improved at each time point after operation(P<0.05).The Cobb's angle and ODI index in PKP group were lower than those in PVP group at each postoperative time point(P<0.05),and the anterior edge height of injured vertebra was higher than that of PVP group(P<0.05).VAS score at 1 day post-operation was lower than that of PVP group(P<0.05).There was no statistically significant difference in VAS scores between the two groups at 3 months post-operation and the last follow-up(P>0.05).There were no statistically significant differences in operation time,hospitalization time,intraoperative blood loss and injection amount of bone cement between the two groups(P>0.05).The incidence of bone cement leakage and secondary vertebral fracture in PVP group was significantly higher than that in PKP group(P<0.05).Conclusion The improvement of Cobb's angle,ODI index,anterior edge height of injured vertebrae and VAS score in PKP group are better than those in PVP group,and the risk of surgical trauma is not increased.