椎体支柱块与经皮PKP治疗胸腰椎压缩性骨折的疗效对比

Efficacy comparison of percutaneous pillar and percutaneous kyphoplasty in the treatment of thoracolumbar compression fractures

目的比较微创经弓根椎体支柱块植入术(Pillar)与经皮球囊扩张椎体后凸成形术(PKP)治疗胸腰椎压缩性骨折的临床疗效。方法前瞻性研究2016年2月—2018年3月西宁市第三人民医收治的单纯胸腰椎压缩性骨折患者67例,男性48例,女性19例;年龄23~82岁,平均48.6岁。采用信封法分为Pillar组(34例)和PKP(33例),Pillar组采用微创经弓根椎体支柱块植入术治疗,共37个椎体;男性25例,女性9例;年龄23~73岁,平均48.4岁;道路交通伤19例,高处坠落伤15例。PKP组采用PKP治疗,共35个椎体;男性23例,女性10例;年龄31~82岁,平均48.8岁;道路交通伤21例,高处坠落伤12例。比较两组患者手术时间、术中出血量和住院时间,术后采用Oswestry功能障碍指数(ODI)和视觉模拟评分(VAS)评价两组临床疗效;比较两组患者术前、术后7d、末次随访Cobb角矫正程度、伤椎前缘高度恢复情况,观察两组患者骨水泥泄露、支柱块移位、迟发性神经损伤、邻近节段退变等并发症发生情况。结果两组患者住院时间比较差异无统计学意义(P>0.05);Pillar组与PKP组比较,手术时间较长[(57.19±5.20)min vs.(51.89±4.90)min]、术中出血量较多[(22.10±4.15)mL vs.(15.35±5.20)mL],差异有统计学意义(P<0.05)。术后门诊随访12~24个月,平均18.3个月。两组患者末次随访ODI、VAS低于术前,但术后两组间比较差异无统计学意义(P>0.05)。Pillar组术后7d及末次随访时Cobb角低于PKP组[11.16±1.73)°vs.(13.75±1.65)°]、[(10.04±1.50)°vs.(12.82±1.70)°],且伤椎前缘高度高于PKP组[(89.15±3.44)mm vs.(86.15±2.94)mm、(91.65±3.12)mm vs.(87.35±3.25)mm],差异有统计学意义(P<0.05)。Pillar组无并发症发生,PKP组骨水泥渗漏2例,并发症发生率6.06%。结论Pillar和PKP均是治疗胸腰椎压缩骨折的有效术式,均能改善患者功能障碍情况,缓解其疼痛症状。Pillar可有效提高患者Cobb角恢复效果和伤椎前缘高度。PKP则缩短手术时间,减少术中出血量。

Objective To compare the clinical efficacy of percutaneous pillar(Pillar)and percutaneous kyphoplasty(PKP)in the treatment of thoracolumbar compression fractures.Methods A prospective study was conducted on 67 patients with simple thoracolumbar vertebral compression fractures treated in the Third People’s Hospital of Xining from Feb.2016 to Mar.2018,including 48 males and 19 females,with an average age of 48.6 years(range,23-82 years).They were divided into Pillar group(n=34)and PKP group(n=33)by envelope method.Patients in the Pillar group were treated with minimally invasive transpedicular vertebral column block implantation,including 37 vertebral bodies.There were 25 males and 9 females,with an average age of 48.4 years(range,23-73 years).There were 19 cases of traffic accident injury and 15 cases of falling from height.In PKP group,35 vertebral bodies were treated with PKP,including 23 males and 10 females,with an average age of 48.8 years(range,31-82 years).There were 21 traffic accident injury and 12 cases of falling from height.The operation time,intraoperative blood loss and hospital stay of the two groups were recorded.The Oswestry disability index(ODI)and visual analogue scale(VAS)were used to evaluate the clinical efficacy of the two groups after operation.The Cobb’s angle correction degree and the recovery of vertebral anterior height were compared.The occurrence of complications such as bone mud leakage,pillar block displacement,delayed nerve injury and adjacent segment degeneration were observed.Results There was no significant difference in hospital stay between the two groups(P>0.05);compared with PKP group,Pillar group had longer operation time[(57.19±5.20)minutes vs.(51.89±4.90)minutes],more intraoperative blood loss[(22.10±4.15)mL vs.(15.35±5.20)mL],and the difference was statistically significant(P<0.05).After 12-24 months follow-up,ODI and VAS scores of the two groups were significantly lower than those before operation,but there was no significant difference between the two groups after operation(P>0.05).Cobb’s angle in Pillar group was lower than that in PKP Group[(11.16±1.73)°vs.(13.75±1.65)°,(10.04±1.50)°vs.(12.82±1.70)°]at 7 days and half a year after operation,and the height of anterior edge of injured vertebra in pillar group was higher than that in PKP group[(89.15±3.44)mm vs.(86.15±2.94)mm,(91.65±3.12)mm vs.(87.35±3.25)mm],and the difference was statistically significant(P<0.05).There was no complication in Pillar group and 2 cases of bone cement leakage in PKP group.The complication rate was 6.06%.Conclusions Both PKP and pillar are effective surgical methods for the thoracolumbar compression fractures,which can improve the patient's dysfunction and relieve the pain symptoms.PKP shortens the operation time and reduces the amount of intraoperative blood loss,while pillar effectively improves the recovery effect of the Cobb’s angle and the height of the anterior edge of the injured vertebra.