微创医学

目的探讨经皮椎弓根螺钉联合伤椎植骨与经皮椎弓根螺联合伤椎后凸成形术治疗无神经症状骨质疏松性胸腰椎爆裂骨折（OVBF）的临床疗效。方法选取72例无神经症状OVBF患者作为研究对象。根据治疗方法，将采用经皮椎弓根螺钉联合伤椎植骨术治疗的患者纳入观察组（n=37），将采用经皮椎弓根螺钉联合伤椎后凸成形术治疗的患者纳入对照组（n=35）。比较两组患者的围术期指标，包括手术时间、术中出血量、术中并发症发生情况、术后下床时间和住院时间，以及术前1 d、术后7 d、术后6个月和术后26个月的疼痛视觉模拟量表（VAS）评分、Oswestry功能障碍指数（ODI）评分、后凸Cobb角、伤椎前缘高度（AVH）比值和胸腰段后凸角（TLK），术后26个月时骨性愈合情况和术后并发症发生情况。结果两组患者的术后下床时间、住院时间比较，差异无统计学意义（均P>0.05）。观察组患者的术中出血量多于对照组、手术时间长于对照组、骨水泥渗漏发生率低于对照组，差异均有统计学意义（均P<0.05）。术后7 d观察组患者的VAS评分高于对照组，术后6个月和术后26个月时观察组患者的ODI评分均低于对照组（均P<0.05）。两组术后7 d、6个月和26个月的后凸Cobb角、AVH比值、TLK差异均无统计学意义（均P>0.05）。末次随访时两组患者的伤椎植骨均达到骨性愈合，观察组术后无一例患者出现并发症，术后并发症发生率低于对照组，差异有统计学意义（P<0.05）。结论经皮椎弓根螺钉联合伤椎植骨和经皮椎弓根螺钉联合伤椎后凸成形术治疗无神经症状OVBF均为安全有效的微创手术方法，但经皮椎弓根螺钉联合伤椎植骨的并发症更少，更能维持术后内固定稳定，减少内固定松动失效风险，值得临床推广。

Objective To investigate the clinical efficacy of percutaneous pedicle screw combined with injured vertebral bone grafting and percutaneous pedicle screw combined with injured vertebral kyphoplasty in the treatment of osteoporotic vertebral burst fractures (OVBF) without neurological symptoms. Methods A total of 72 patients with OVBF without neurological symptoms were selected as research objects. According to the treatment methods, patients treated with percutaneous pedicle screw combined with injured vertebral bone grafting were included in the observation group (n=37), and patients treated with percutaneous pedicle screw combined with kyphoplasty of the injured vertebrae were included in the control group (n=35). Perioperative indexes of the two groups were compared, including operation time, intraoperative blood loss, occurrence of intraoperative complications, postoperative postoperative ambulation time and hospital stay, as well as pain visual analogue scale (VAS) score, Oswestry disability index (ODI) score, Cobb Angle of kyphosis, anterior vertebral height (AVH) ratio and thoracolumbar kyphosis (TLK) at 1 day before operation, 7 days, 6 months and 26 months after operation, and the bony union and occurrence of postoperative complications at 26 months after operation. Results There were no statistically significant differences in the ambulation time and hospital stay between the two groups (all P>0.05). Compared with the control group, the observation group had higher intraoperative blood loss, longer operation time and lower incidence of bone cement leakage, with statistically significant differences (all P<0.05). The VAS score of the observation group was higher than that of the control group at 7 days after operation, and the ODI score of the observation group was lower than that of the control group at 6 months and 26 months after operation (all P<0.05). There were no statistically significant differences in the Cobb Angle of kyphosis, AVH ratio and TLK between the two groups at 7 days, 6 months and 26 months after operation (all P>0.05). At the last follow-up, both groups of patients achieved bony union after vertebral bone grafting. There were no postoperative complications in the observation group, and the incidence of postoperative complications was significantly lower than that in the control group (P<0.05). Conclusion Both percutaneous pedicle screw combined with injured vertebral bone grafting and percutaneous pedicle screw combined with injured vertebral kyphoplasty are safe and effective minimally invasive surgical methods for the treatment of OVBF without neurological symptoms. However, percutaneous pedicle screw combined with injured vertebral bone grafting has fewer complications, can maintain the stability of postoperative internal fixation, and reduce the risk of internal fixation loosening and failure, which is worthy of clinical promotion.

ref
ref
ref
ref
ref
ref
ref
ref
ref
ref
ref
ref
ref
ref
ref
ref
ref
ref
ref