摘要
目的 比较不同手术方法治疗60~69岁间胸腰椎骨质疏松椎体压缩性骨折(非陈旧性)患者的临床效果。方法 选取2014年1月至2020年1月收治的骨质疏松性胸腰椎压缩性骨折,并在东部战区总医院骨科行手术治疗的34例患者。采用完全随机法将患者分为2组。其中一组对患椎行椎体后凸成形术(KP组);另一组行后路经Wiltse入路短节段椎弓根螺钉内固定术(PS组)。比较2组患者术中及术后各项指标差异。结果 相比于PS组,KP组患者术中失血量更少,手术时间更短,住院总花费更低。KP组患者术后短期内椎体前缘高度(AH)、椎体中部高度(CH)、椎体后凸角度(KA)均有所恢复;但术后3个月AH、CH、KA值有所丢失。PS组术后AH、CH和KA均得到改善,且术后1年内AH、CH、KA保持了稳定。KP组的患者术后疼痛数字评分(NRS)及Oswestry功能障碍指数(ODI)均明显下降,改善在术后前3个月内比较明显,在术后3个月2项评分均有所增高。PS组在术后短期内NRS评分和ODI指数低于KP组,但在3个月以后则优于KP组。并发症方面,术中KP组中有7例术中发生骨水泥渗漏,但均为椎旁及椎前小范围渗漏,未造成临床症状。2组患者术中均无椎前大血管损伤、肺栓塞、器官损伤等严重手术并发症发生;术后均无肺炎、褥疮、尿路感染、下肢静脉血栓等卧床相关并发症发生;KP组和PS组均未发生切口感染;KP组有4例在半年内发生临近节段椎体骨折;而PS组无一例发生。结论 对于年龄段在60~69岁间,且诊断为骨质疏松性椎体骨折,但骨密度T值在-1~-2.5SD之间的低龄老人,椎弓根螺钉短节段固定和椎体强化术均可以作为治疗方式。对于身体状况佳的低龄老人建议使用椎弓根螺钉短节段固定,长期效果更好;而对体弱多病、身体状况不佳、活动量少的低龄老人建议使用椎体强化术来治疗。
Objective To investigate the effects of kyphoplasty versus pedicle screw via Wiltse approach for osteoporotic vertebral compression fresh fracture with the young-old aged between 60 to 69 years old. Methods A total of 34 elderly patients with osteoporotic vertebral compression fractures were selected from January 2014 to January 2020. Those patients were treated with surgical method in our department. The patients were randomly divided into two groups with 17 persons in each group. One group was treated with kyphoplasty(KP) to the fractured vertebrae, and the other was fixated with pedicle screw(PS) via Wiltse approach There was no statistical difference in gender, age, and number of fractures between the two groups. Results The intraoperative blood loss for the kyphoplasty group(KP group) was significantly less than that in the pedicle screw fixation group(PS group). The operation time in the KP group was less than that in the PS group. The total cost of hospitalization in the KP group was less than that in the PS group. The anterior height(AH), central height(CH), and kyphotic angulation(KA) of the vertebral body all recovered within a short period of time after KP, but 3 months after KP the values of AH, CH, and KA were lower. The AH, CH, and KA all recovered and remained stable for one year after PS fixation. The numerical rating scale(NRS) and Oswestry Disability Index(ODI) were found to decline after KP but improved obviously in 3 months. The PS group’s RNS score and ODI index were inferior to that of the KP group in the short-term after surgery, but they were better than that of the KP group after 3 months. In terms of intraoperative and postoperative complications, both groups had no pneumonia, bedsores, urinary tract infections, and phlebothrombosis. Neither group had serious complications such as large vessel injury, pulmonary embolism, or organ injury. There was no wound infection in both groups. The slight bone cement leakage in the thoracic vertebra without clinical symptoms occurred in 7 cases in
作者
丛宇
缪吴军
包倪荣
CONG Yu;MIAO Wu-jun;BAO Ni-rong(Department of Orthopedics,General Hospital of Eastern Theater Command,PLA,Nangjing 210002,Jiangsu,Chi-na)
出处
《医学研究生学报》
CAS
北大核心
2022年第9期959-964,共6页
Journal of Medical Postgraduates
基金
江苏省卫生健康委科研项目面上基金(H2019022)。
