背景：经皮椎体成形、经皮椎体后凸成形和膨胀式椎弓根螺钉内固定均可修复原发性骨质疏松性胸腰椎骨折，这3种方法各有其优缺点。 目的：探讨原发性骨质疏松性胸腰椎骨折的修复方式及效果。 方法：纳入61例诊断为原发性骨质疏松性胸腰椎骨折的患者，入院后积极做好围手术期的治疗和处理，分别采取经皮椎体成形、经皮椎体后凸成形和膨胀式椎弓根螺钉置入内固定治疗，记录所有患者术前、术后3个月的疼痛目测类比评分和Oswestry功能障碍指数(ODI)，以及术前、术后3 d及术后3个月伤椎的矢状面指数和Cobb角等指标并进行统计分析。 结果与结论：①所有患者术后均获得随访，随访时间12-18个月；②3组患者术前的疼痛目测类比评分、ODI、伤椎的矢状面指数及Cobb角比较差异无显著性意义(P>0.05)；③3组术后3个月的疼痛目测类比评分、ODI均较术前降低，差异有显著性意义(P<005)，组间比较疼痛目测类比评分、ODI差异无显著性意义(P>0.05)；④3组术后3 d、术后3个月伤椎的矢状面指数、Cobb角均较术前增大，差异有显著性意义(P<005)，组间比较差异有显著性意义(P<005)，经皮椎体后凸成形组与膨胀式椎弓根螺钉内固定组效果类似(P>0.05)，且优于经皮椎体成形组(P<0.05)；⑤结果说明，3种修复方式均能有效恢复椎体高度和强度，缓解疼痛，稳定脊柱，术后短期内椎体无明显的压缩；但在术后椎体高度的恢复程度方面，经皮椎体后凸成形、膨胀式椎弓根螺钉内固定优于经皮椎体成形。另外，3种修复方案均有各自的适应证、优缺点，正确选择修复方式是提高修复效果的关键。%BACKGROUND:Percutaneous vertebroplasty, percutaneous kyphoplasty and expandable pedicle screw fixation can treat primary osteoporotic thoracolumbar fractures. The three methods have their own advantages and disadvantages. OBJECTIVE:To investigate the methods and clinical effects of primary osteoporotic thoracolumbar fractures. METHODS:Clinical data of 61 patients with primary osteoporotic thoracolumbar fractures were col ected and retrospectively analyzed. Perioperative preparation must be done. Al patients were treated by percutaneous vertebroplasty, percutaneous kyphoplasty and expansive pedicle screw fixation. We recorded Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI) before treatment, 3 months after treatment, as wel as sagittal index (SI) and Cobb angle of vertebral fracture before treatment, 3 days and 3 months after treatment. RESULTS AND CONCLUSION:(1) Al cases were fol owed up for 12-18 months. (2) There was no significant difference in VAS scores, ODI, SI and Cobb angle of vertebral fracture among the three groups of patients preoperatively. (3) At 3 months after treatment, there were significant differences in VAS scores and ODI in the three groups as compared with that preoperation (P<0.05). However, no significant difference in VAS and ODI was determined among intergroup comparison (P>0.05). (4) SI and Cobb angle of vertebral fracture were significantly increased;the difference was statistical y significant (P<0.05). The efficacy was similar between the percutaneous kyphoplasty and expansive pedicle screw fixation groups (P>0.05), and was better than the percutaneous vertebroplasty group (P<0.05). (5) Three kinds of treatment can effectively restore the vertebral height and intensity, relieve pain and stabilize the spine, and no significant vertebral compression was found in the short term. However, restoration of postoperative vertebral height was better in percutaneous kyphoplasty and expansive pedicle screw fixation groups than in the percutaneous vertebroplasty group. In view of their respective indications, advantages and disadvantages, the key point of raising therapeutic effect was to choose appropriate surgical procedures.
展开▼
