迟发性骨质疏松椎体塌陷的2种手术方式的比较

Comparative Study of Two Surgical Procedures for Osteoporotic Delayed Vertebral Collapse

目的探讨迟发性骨质疏松椎体塌陷有效治疗方法。方法选取研究纳入2013年3月至2018年3月期间入住解放军联勤保障部队九二〇医院,不伴有神经症状的迟发性骨质疏松椎体塌陷患者,接受经后路内固定联合椎体成形术(PFV组)或经皮穿刺椎体后凸成形术(PKP组)。比较两组患者围手术期临床结果和影像学参数及远期并发症。结果术后PFV组伤椎前缘高度和局部Cobb角恢复显著优于PKP组(P<0.001)。术后1周VAS评分和ODI值评分PKP组均优于PFV组(P=0.03)。PFV组术后发生相邻椎体骨折1例(4%),钉棒内固定松动2例(8%)。PKP组4例(18%)术后发生严重后凸畸形,2例出现神经症状,行2次手术治疗。结论迟发性骨质疏松椎体塌陷的手术治疗,PFV和PKP均能取得满意的临床疗效,PKP适用于单椎体且脊柱矢状面无明显改变的患者,而PFV更适用于脊柱矢状位明显改变的迟发性骨质疏松椎体塌陷患者。

Objective To explore the effective treatment for osteoporotic delayed vertebral collapse.Methods Between March 2013 and March 2018,a total of 46 patients with osteoporotic delayed vertebral fracture with no or mild neurological symptoms were enrolled in our hospitals.24 patients underwent posterior fixation with vertebroplasty(PFV group),and 22 patients underwent percutaneous balloon kyphoplasty(PKP group).The clinical results,imaging parameters and long-term complications were compared between the two groups.Results Postoperative PFV group had significantly higher vertebrae height and local Cobb angle recovery than PKP group(P<0.001).The VAS score and ODI score in the PKP group were better than those in the PFV group(P=0.03).There was no significant difference between the two groups at the last follow-up(P=0.28).In the PFV group,3 cases(12.5%)had adjacent vertebral fractures,3 cases(16.7%)had internal fixation loosening,and 1 case(4.5%)had revision surgery.In the PKP group,4 cases had severe kyphosis,2 cases had neurological symptoms,and 2 cases underwent revision surgery.Conclusions Both PFV and PKP for delayed osteoporosis vertebral collapse can achieve satisfactory clinical results.PFVB is indicated for patients with a significant change in the sagittal position of the spine,whereas PKP is suitable for a single vertebral body and no significant changes in the sagittal plane of the spine.