经皮内固定联合伤椎成形术与网袋椎体成形术治疗骨质疏松胸腰段爆裂骨折的对比研究

Percutaneous pedicel screw fixation combined with vertebroplasty versus vesselplasty for osteoporotic thoracolumbar burst fracture

目的比较经皮椎弓根螺钉内固定联合伤椎成形术(PPSF+PVP)与网袋椎体成形术(VP)治疗骨质疏松胸腰段爆裂骨折(OTBF)的疗效。方法回顾性分析2016年1月至2019年9月本院收治的65例无脊髓神经症状骨质疏松胸腰段爆裂骨折患者资料,根据手术方式不同将患者分为PPSF+PVP术组(A组,32例)和VP术组(B组,33例)。比较两组手术时间、术中出血量、透视时间、骨水泥注入量、骨水泥渗漏率、再骨折发生率、视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、伤椎前缘高度比和Cobb角。结果A组手术时间、术中出血量、透视时间和骨水泥注入量均大于B组(P<0.05)。两组骨水泥渗漏率和再骨折发生率无显著差异(P>0.05)。两组术后3天、术后1年的VAS评分、ODI指数、伤椎前缘高度比和Cobb角均较术前明显改善(P<0.05)。A组术后3天VAS评分和ODI指数均大于B组(P<0.05),术后1年VAS评分和ODI指数均小于B组(P<0.05);A组术后3天、术后1年的伤椎前缘高度比均大于B组(P<0.05),Cobb角均小于B组(P<0.05)。结论PPSF+PVP术相比VP术更有利于恢复伤椎椎体高度和矫正后凸畸形,临床疗效更优。VP术创伤小、恢复快,对于严重骨质疏松、不能耐受全身麻醉或合并严重内科疾病的OTBF患者,可选择VP术。两种术式都值得临床推广应用。

Objective To compare the clinical efficacy between percutaneous pedicel screw fixation combined with vertebroplasty(PPSF+PVP)and vesselplasty(VP)for osteoporotic thocarolumbar burst fracture(OTBF).Methods A retrospective study was performed for 65 patients with osteoporotic thoracolumbar burst fracture without nerve injury treated in our hospital from January 2016 to September 2019.32 patients were treated by PPSF+VP(Group A)and 33 patients were treated by VP(Group B).The operation time,intraoperative blood loss,intraoperative fluoroscopy time,bone cement perfusion,bone cement leakage rate,incidence of refracture,visual analogue score(VAS),oswestry disability index(ODI),injured vertebral anterior border height and Cobb angle were compared between group A and group B.Results The operation time,intraoperative blood loss,intraoperative fluoroscopy time and bone cement perfusion in group A were greater than those in group B(P<0.05).There were no significant differences in bone cement leakage rate and incidence of refracture between the two groups(P>0.05).VAS,ODI,injured vertebral anterior border height and Cobb angle in two groups at 3 days and 1 year post-operation were better than before operation(P<0.05).VAS and ODI in group A were greater than in group B at 3 days post-operation(P<0.05),and were less than in group B at 1 year post-operation(P<0.05).At 3 days and 1 year post-operation,injured vertebral anterior border height in group A were greater than in group B(P<0.05),and Cobb angle in group A were less than in group B(P<0.05).Conclution compared with VP,PPSF+PVP is more beneficial to restore injured vertebra height and correct kyphosis,it has better clinical efficacy.VP gives advantages of minimal invasion and quick recovery,which can be selected for OTBF patients with severe osteoporosis,intolerance to general anesthesia or combined with serious medical diseases.Both surgical methods are worthy of clinical application.