微创医学

目的探讨术中持续牵引结合手法复位及经皮椎体成形术（PVP）治疗老年骨质疏松性腰椎压缩性骨折的临床疗效和安全性。方法回顾性分析109例老年骨质疏松性腰椎压缩性骨折患者的临床资料，将采用术中骨科牵引架持续牵引结合正骨手法复位联合PVP治疗的患者纳入联合组(n=67)，采用单纯PVP治疗的患者纳入PVP 组(n=42) 。比较两组患者术前、术后2 d、术后3个月、术后1年的Cobb角、伤椎高度、VAS评分、Oswestry功能障碍指数（ODI）评分，以及术中和术后并发症的发生情况。结果术前，两组患者的Cobb角、伤椎高度、VAS评分、ODI评分比较，差异均无统计学意义(均P＞0.05)。术后2 d、3个月、1年，联合组患者的Cobb角均较术前明显缩小且均小于PVP组、伤椎高度均大于术前且大于PVP组（均P＜0.05），而术后各时间点PVP组患者的Cobb角和伤椎高度与术前差异均无统计学意义（均P＞0.05）；术后2 d、3个月、1年，两组患者的VAS评分、ODI评分均较术前低且联合组评分均低于PVP组(均P＜0.05)。术后联合组患者骨水泥椎管内渗漏、邻椎骨折等并发症发生率低于PVP组（P＜0.05）。结论术中骨科牵引架持续牵引结合正骨手法复位及PVP治疗老年骨质疏松性腰椎压缩性骨折，可纠正腰椎后凸畸形、恢复伤椎高度、缓解腰背部疼痛、改善腰椎功能，且安全性高。

ObjectiveTo investigate the clinical efficacy and safety of intraoperative continuous traction combined with manual reduction and percutaneous vertebroplasty (PVP) in the treatment of senile osteoporotic lumbar compression fractures. MethodsThe clinical data of 109 elderly patients with osteoporotic lumbar compression fractures were retrospectively analyzed. The patients who adopted the intraoperative continuous traction of orthopedic traction frame combined with manual reduction of bone-setting and PVP were divided into the combination group (n=67), and patients who adopted PVP treatment alone were included in the PVP group (n=42). The Cobb angle, injured vertebral height, VAS score, Oswestry dysfunction index (ODI) score before operation, 2 days, 3 months，and 1 year after operation were compared between the two groups, as well as the occurrence of intraoperative and postoperative complications. ResultsBefore operation, there was no statistically significant difference in the Cobb angle, injured vertebral height, VAS score and ODI score between the two group (all P＞0.05). Two days, 3 months and 1 year after operation, the Cobb angle of the combined group was significantly reduced than that before operation and smaller than that in the PVP group, and the injured vertebral height was greater than that before operation and that in the PVP group (all P＜0.05). However, there was no statistically significant difference in the Cobb angle and injured vertebral height between preoperative and postoperative time points in the PVP group (all P＞0.05). Two days, 3 months, and 1 year after operation, VAS scores and ODI scores of the two groups were lower than those before operation, while those of the combination group were lower than those of the PVP group (all P＜0.05). After operation, the incidence of complications such as intraspinal bone cement leakage and adjacent vertebral fracture in the combination group was lower than that in the PVP group (P＜0.05). ConclusionThe intraoperative continuous traction of orthopedic traction frame combined with manual reduction of bone-setting and PVP in the treatment of senile osteoporotic lumbar compression fracture can correct lumbar kyphosis, restore the injured vertebral height, relieve back pain, and improve lumbar function, with high safety.