胸腰椎骨质疏松性骨折三点复位椎体后凸成形术

Three- point reduction combined with percutaneous kyphoplasty for thoracolumbar osteoporotic fractures

摘要:

[目的] 探讨采用三点复位联合经皮球囊扩张后凸椎体成形术(percutaneous kyphoplasty, PKP)治疗伴椎体后壁破裂胸腰椎骨质疏松性椎体压缩骨折 (osteoporotic vertebral compression fracture, OVCF) 的安全性和有效性。[方法] 回顾性分析 2019 年 1 月—2020 年 10 月本科收治的 95 例 OVCF 患者的临床资料，依据术前影像，12 例伴有椎体后壁破裂，83 例无后壁破裂。两组患者均先采用三点复位，再行 PKP 技术治疗。比较两组围手术期、随访及影像资料。[结果]所有患者均顺利完成手术，均无严重并发症发生。两组手法复位时间、手术时间、透视次数、骨水泥注入量、骨水泥渗漏率、下地活动时间、住院时间的差异均无统计学意义(P＞0.05)。所有患者均获随访(15.03±6.77)个月。两组恢复完全负重活动时间的差异无统计学意义 (P＞0.05)。随时间推移，两组腰痛 VAS 及 ODI 评分显著降低 (P＜0.05)，相应时间点，两组之间 VAS 及 ODI 评分的差异均无统计学意义 (P＞0.05)。影像方面，与术前相比，两组术后伤椎椎体前缘高度显著增加 (P＜0.05)，局部 Cobb 角显著减小 (P＜ 0.05)。术前破裂组伤椎椎体前缘高度显著低于未破裂组(P＜0.05)，但两组伤椎局部 Cobb 角差异无统计学意义(P＞0.05)；术后相应时间点，两组伤椎椎体前缘高度、局部 Cobb 角的差异均无统计学意义(P＞0.05)。[结论]三点复位联合 PKP 技术治疗 OVCF 安全有效，尤其是伴椎体后壁破裂的 OVCF 患者，能够恢复椎体高度，缓解疼痛。

Abstract:

[Objective] To investigate the safety and clinical outcomes of three-point reduction combined with percutaneous kyphoplas- ty (PKP) for thoracolumbar osteoporotic vertebral compression fracture (OVCF) complicated with posterior wall rupture. [Methods] A retro- spective study was done on 95 patients who received surgical treatment for OVCF in our hospital from January 2019 to October 2020. Based on preoperative radiographs, 12 patients were complicated with the posterior wall rupture (the rupture group) , while the remaining 83 pa- tients had no posterior wall rupture (non-rupture group) . All the patients in both groups were treated with three-point reduction, followed by PKP. The data regarding to perioperative period, follow-up and images were compared between the two groups. [Results] All the pa- tients in both groups had operation performed smoothly without serious complications. There were no significant differences between the two groups in terms of reduction time, operation time, fluoroscopy times, volume of bone cement injected, bone cement leakage, postopera- tive walking time and hospital stay (P＞0.05) . All of them in both groups were followed up for (15.03±6.77) months on an average, without a significant difference between the two groups in the time to resume full weight-bearing activity (P＞0.05) . The VAS and ODI scores signifi- cantly decreased in both groups over time (P＜0.05) , whereas which proved not statistically significant between the two groups at any match- ing time points (P＞0.05) . Radiographically, the anterior vertebral height significantly increased (P＜0.05) , whereas the local kyphotic Cobb angles significantly decreased in both groups postoperatively compared with those preoperatively (P＜0.05) . Although the rupture group had significantly lower anterior vertebral height than the non-rupture group preoperatively (P＜0.05) , there were no statistically significant dif- ferences in terms of anterior vertebral height and local kyphotic Cobb’s angle between the two groups postoperatively (P＞0.05) . [Conclusion] The three-point reduction combined with PKP is safe and effective for treatment of OVCF, especially complicated with posterior wall rupture, which restore the height of the vertebral body and relieve pain.