椎弓根螺钉与椎体成形术或中间螺钉治疗骨质疏松性胸腰椎压缩性骨折的疗效比较

中华创伤杂志 Pub Date : 2019-08-15 DOI:10.3760/CMA.J.ISSN.1001-8050.2019.08.008

Bolong Zheng, D. Hao, Liang Yan, Zheng-wei Xu, Simin He, Xiaobin Yang, B. He

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Among all patients, 68 received PSV treatment (PSV group) and 73 received fixed PSIS treatment (PSIS group). The operation time, intraoperative blood loss, visual analogue scale (VAS), anterior height ratio, central height ratio, and segmental kyphosis angle at 3 days, 3 months, 6 months, 1 year and 2 years after operation were compared between the two groups. The complications were recorded. \n \n \nResults \nAll patients were followed up for 25-31 months, with an average of 27.9 months. There were no significant differences in operation time and intraoperative blood loss between the two groups (P>0.05). VAS at each time point of postoperative follow-up was significantly lower than those before operation in both groups (P 0.05). Anterior height ratios of PSV group were higher than those of PSIP group at postoperative 3 months, 6 months, 1 year and 2 years (P<0.05) [(95.2±5.2) vs. (92.6±7.1), (93.8±5.2) vs. (91.4±3.2), (93.3±4.9) vs. (91.2±5.1), (92.6±5.5) vs. (90.1±4.7)]. The central height ratios of PSV group were higher than those of PSIP group at postoperative 6 months, 1 year and 2 years [(91.4 ±6.9) vs. (88.9±7.2), (90.8±7.4) vs. (88.4±5.9), (90.1±7.6) vs. (87.1±7.2)](P<0.05). Segmental kyphosis angle of PSV group was lower than that of PSIP group at postoperative 3 months, 6 months, 1 year and 2 years [(2.9±0.4)° vs. (3.2±0.9)°, (3.0±0.5)° vs. (3.2±0.3)°, (3.1±0.7)° vs. (3.4±0.4)°, (3.1±0.4)° vs. (3.4±0.7)°](P<0.05 or 0.01). Bone cement leakage from screws occurred in two patients in PSV group and three patients in PSIS group. Cement leakage occurred in the injured vertebra in four patients of PSV group, with no any symptom. In PSIS group, two patients suffered from one side rod breakage at 9 months and 1 year after surgery, respectively. 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引用次数: 0

摘要

目的比较椎弓根螺钉加椎体成形术（PSV）和中间螺钉（PSIS）治疗骨质疏松性胸腰椎压缩性骨折的疗效。方法对西安交通大学医学院红会医院2012年1月1日至2015年12月31日收治的141例骨质疏松性胸腰椎压缩性骨折患者的临床资料进行回顾性病例对照研究。男59例，女82例，年龄60-75岁，平均年龄65.4岁。所有骨折的骨密度（BMD）T值均为15度或前柱压缩>40%。胸椎骨折65例（T10-T12），腰椎骨折76例（L1-L4）。在所有患者中，68例接受PSV治疗（PSV组），73例接受固定PSIS治疗（PSIS组）。比较两组术后3天、3个月、6个月、1年和2年的手术时间、术中出血量、视觉模拟评分（VAS）、前部高度比、中心高度比和节段性后凸角。记录并发症。结果所有患者随访25-31个月，平均27.9个月。两组手术时间和术中出血量差异无统计学意义（P>0.05）。两组术后随访各时间点VAS评分均显著低于术前（P<0.05），1年2年（P<0.05）[（95.2±5.2）vs.（92.6±7.1），（93.8±5.2）vs（91.4±3.2），（933±4.9）vs，1年2年[（91.4±6.9）vs.（88.9±7.2），（90.8±7.4）vs，1年零2年[（2.9±0.4）°vs.（3.2±0.9）°，（3.0±0.5）°vs.········3.2±0.3）°，···3.1±0.7···3.4±0.4···（3.1±0.4）···3.4±0.7）°]（P＜0.05或0.01）。PSV组2例，PSIS组3例发生螺钉骨水泥渗漏。PSV组4例伤椎出现骨水泥渗漏，无任何症状。在PSIS组中，两名患者分别在术后9个月和1年出现单侧杆断裂。CT显示骨愈合良好，无需进一步治疗。结论对于骨质疏松性胸腰椎压缩性骨折，PSV可获得与PSIS相似的疼痛缓解，但前者更有利于减少前中柱高度的损失和矫正后凸畸形。关键词：骨质疏松性骨折；脊柱骨折；骨水泥

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Efficacy comparison of pedicle screw with vertebroplasty or intermediate screw for osteoporotic thoracolumbar compression fractures

Objective To compare the efficacy of pedicle screw with vertebroplasty (PSV) or intermediate screw (PSIS) for osteoporotic thoracolumbar compression fractures. Methods A retrospective case control study was conducted to analyze the clinical data of 141 patients with osteoporotic thoracolumbar vertebral compression fractures admitted to Honghui Hospital, College of Medicine, Xi'an Jiaotong University from January 1, 2012 to December 31, 2015. There were 59 males and 82 females, aged 60-75 years, with an average age of 65.4 years. All the fractures had bone mineral density (BMD) T value 15 degrees or anterior column compression > 40%. There were 65 patients with thoracic vertebral fractures (T10-T12) and 76 with lumbar vertebral fractures (L1-L4). Among all patients, 68 received PSV treatment (PSV group) and 73 received fixed PSIS treatment (PSIS group). The operation time, intraoperative blood loss, visual analogue scale (VAS), anterior height ratio, central height ratio, and segmental kyphosis angle at 3 days, 3 months, 6 months, 1 year and 2 years after operation were compared between the two groups. The complications were recorded. Results All patients were followed up for 25-31 months, with an average of 27.9 months. There were no significant differences in operation time and intraoperative blood loss between the two groups (P>0.05). VAS at each time point of postoperative follow-up was significantly lower than those before operation in both groups (P 0.05). Anterior height ratios of PSV group were higher than those of PSIP group at postoperative 3 months, 6 months, 1 year and 2 years (P<0.05) [(95.2±5.2) vs. (92.6±7.1), (93.8±5.2) vs. (91.4±3.2), (93.3±4.9) vs. (91.2±5.1), (92.6±5.5) vs. (90.1±4.7)]. The central height ratios of PSV group were higher than those of PSIP group at postoperative 6 months, 1 year and 2 years [(91.4 ±6.9) vs. (88.9±7.2), (90.8±7.4) vs. (88.4±5.9), (90.1±7.6) vs. (87.1±7.2)](P<0.05). Segmental kyphosis angle of PSV group was lower than that of PSIP group at postoperative 3 months, 6 months, 1 year and 2 years [(2.9±0.4)° vs. (3.2±0.9)°, (3.0±0.5)° vs. (3.2±0.3)°, (3.1±0.7)° vs. (3.4±0.4)°, (3.1±0.4)° vs. (3.4±0.7)°](P<0.05 or 0.01). Bone cement leakage from screws occurred in two patients in PSV group and three patients in PSIS group. Cement leakage occurred in the injured vertebra in four patients of PSV group, with no any symptom. In PSIS group, two patients suffered from one side rod breakage at 9 months and 1 year after surgery, respectively. CT showed sound bone healing, without any further management. Conclusion For osteoporotic thoracolumbar compression fractures, PSV can attain similar pain relief compared with PSIS, but the former is more conducive to reducing the loss of anterior and middle column height and correcting kyphosis deformity. Key words: Osteoporotic fractures; Spinal fractures; Bone cement

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中华创伤杂志

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期刊介绍： Chinese Journal of Trauma (International Standard Serial Publication Number: ISSN 1001-8050, Domestic Uniform Serial Publication Number: CN 50-1098/R) was founded in September 1985, which is the only high-level medical professional academic journal that can comprehensively and systematically reflect the achievements and development trends of China's traumatology medicine, and has a wide academic influence in China's traumatology medicine community. It has a wide range of academic influence in China's trauma medicine. Chinese Journal of Trauma is a source journal of China Science and Technology Paper Statistics, a source journal of China Science Citation Database (CSCD), a core journal of China Comprehensive Medicine and Health Care, a source journal of China Academic Journals Comprehensive Evaluation Database (CAJCED), a full-text journal of China Journal Full-text Database (CJFD), a core academic journal of China Center for Scientific Evaluation (RCCSE), a core academic journal of China Traumatology and Traumatology Center (CTC), a core academic journal of China Traumatology Center (RCCSE). RCCSE) core academic journals; Chinese Biomedical Journal Database (CMCC), Chinese Biomedical Journal Citation Database (CBJCED), China Journal Network (CJN), China Academic Journals (CD-ROM), Chinese Academic Journals Abstracts (Chinese Edition), Chemical Abstracts of the United States (CA), Index Copernicus of Poland (IC), and Japan Institute of Science and Technology Database (JICST), World Health Organization Western Pacific Region Medical Search (WPRIM) and Russian Journal of Abstracts (ΡЖ) included journals.