Percutaneous vertebroplasty, percutaneous kyphoplasty and expansive pedicle screw fixation for repairing primary osteoporotic thoracolumbar fractures

doi:10.3969/j.issn.2095-4344.2017.03.005

Abstract

Abstract:

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 collected and retrospectively analyzed. Perioperative preparation must be done. All 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 well as sagittal index (SI) and Cobb angle of vertebral fracture before treatment, 3 days and 3 months after treatment.

RESULTS AND CONCLUSION: (1) All cases were followed 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 statistically 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.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Osteoporosis, Spinal Fractures, Vertebroplasty, Tissue Engineering

CLC Number:

R318

Wang Ling, Zhao Hong-xia, Hua Qiang. Percutaneous vertebroplasty, percutaneous kyphoplasty and expansive pedicle screw fixation for repairing primary osteoporotic thoracolumbar fractures [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(3): 350-355.

Figures/Tables 2

2.2 基线资料比较 3组患者术前性别分布、年龄及各伤椎体分布情况差异无显著性意义(P > 0.05)，具有可比性，见表1。 2.3 患者术后一般情况 3组所有患者均顺利完成手术，术后手术切口均Ⅰ/甲愈合，术后未发生脊髓和神经损伤，围手术期内未发生心脑血管意外或死亡等并发症。所有患者术后均获得随访，随访时间12-18个月。术前患者伴有神经功能障碍(Frankel脊髓损伤分级：B级2例，C级4例，D级6例)并经MRI或CT检查证实有椎管占位的影像学表现者12例，其中10例均采取膨胀式椎弓根螺钉置入内固定治疗，余2例因内科基础疾病复杂，术前评估无法耐受麻醉及手术风险，采取局麻下行经皮椎体后凸成形治疗，术后3个月12例患者Frankel脊髓损伤分级均较前有所改善，见表2。 2.4 术前术后疼痛目测类比评分、ODI的比较 3组患者术前的疼痛目测类比评分、ODI比较差异无显著性意义(P > 0.05)；3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 < 0.05)，组间比较疼痛目测类比评分、ODI差异无显著性意义(P > 0.05)，见表3。 2.5 术前、术后伤椎矢状面指数、Cobb角的比较 3组患者术前伤椎的矢状面指数、Cobb角比较差异无显著性意义(P > 0.05)；3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 < 0 05)，组间比较差异有显著性意义(P < 0 05)，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)，见表3。 2.6 典型病例患者，女，67岁，弯腰轻微外力致腰背部疼痛伴活动受限3 h后入院，11 d后行切开复位膨胀式椎弓根螺钉内固定系统治疗，见图2。 2.7 不良事件所有病例全部纳入随访研究，无不良事件发生。 "

References

[1] 郑光新,赵晓鸥,刘广林,等. Oswestry功能障碍指数评定腰痛患者的可信性[J]. 中国脊柱脊髓杂志,2002,12(1):13-15.

[2] Kharal M, Al-Hajjaj A, AI-Ammri M, et al. Meeting the American Diabetic Association standards of diabetic care. Saudi J Kidney Dis Transpl. 2010;21(4):678-685.

[3] 周伟. 高黏度骨水泥及其椎体成形治疗重度骨质疏松性胸腰椎骨折[J]. 中国组织工程研究,2015,19(46):7534-7538.

[4] 郑灿,胡德志,李笔锋,等.术前垫枕结合经皮椎体成形术治疗骨质疏松性胸腰椎压缩性骨折的临床效果观察[J]. 中国医药导报, 2016,13(30):91-94.

[5] 唐波.垫枕复位配合经椎弓根植骨治疗胸腰椎爆裂骨折的临床疗效观察[D].湖南中医药大学,2014.

[6] Gong HS,Oh WS,Chung MS,et al. Patients with wrist fractures are less likely to be evaluated and managed for osteoporosis. J Bone Joint Surg Am. 2009;91:2376-2380.

[7] 邓飞鹏.椎体骨水泥注入联合抗骨质疏松药物治疗急性骨质疏松性椎体压缩性骨折临床疗效观察[J].现代诊断与治疗,2015, 26(19):4428-4429.

[8] 刘瑶瑶,孙东,张泽华,等.用于骨质疏松椎体固定的椎弓根螺钉进展[J].中国矫形外科杂志, 2011,19(23): 1982-1986.

[9] Gaines RW Jr. The use of pedicle-screw internal ixation for the operative treatment of spinal disorders. J Bone Joint Surg (Am). 2000;82-A(10): 1458-1476.

[10] Campbell PG, Harrop JS. Incidence of fracture in adjacent levels in patients treated with balloon kyphoplasty: a review of the literature. Curr Rev Musculoskelet Med. 2008;1(1): 61-64.

[11] Tseng YY, Su CH, Lui TN, et al. Prospective comparison of the therapeutic effect of teriparatide with that of combined vertebroplasty with antiresorptive agents for the treatment of new-onset adjacent vertebral compression fracture after percutaneous vertebroplasty. Osteoporos Int. 2012;23(5): 1613-1622.

[12] 王翀,李京,田征,等.经皮椎体成形术与非手术治疗骨质疏松性椎体压缩骨折的Meta分析[J].中国矫形外科杂志,2014,22(6): 493-498.

[13] Nagad P, Rawall S, Kundnani V, et al. Postvertebroplasty instability. J Neurosurg Spine. 2012;16(4):387-393.

[14] 周炳荣,张杰,朱建平,等. PKP球囊扩张体积对骨水泥注射剂量及邻椎再骨折的影响[J].江苏医药,2016,42(15):1713-1715.

[15] 王月,孔庆海,王铁铸,等. 椎体成形术后相邻椎体再骨折的临床研究[J]. 中国骨质疏松杂志,2013,19(3):243-246.

[16] 张震. 球囊扩张椎体后凸成形术治疗老年骨质疏松脊柱压缩骨折的适应症和并发症的初步探讨[J]. 中国医学工程,2014,22(2):167.

[17] 高明暄,李旭升,甄平,等.骨密度对膨胀式椎弓根螺钉固定强度影响的力学研究[J]. 中国修复重建外科杂志, 2013, 27(8): 969-973.

[18] Lei W, Wu Z. Biomechanical evaluation of an expansive pedicle screw in calf vertebrae. Eur Spine J. 2006;15(3): 321-326.

[19] 石磊,王陵,雷伟,等.低弹性模量膨胀螺钉在骨质疏松绵羊的体内研究[J]. 中国骨质疏松杂志, 2011, 17(9): 761-765.

[20] Chen LH, Hsieh MK, Liao JC, et al. Repeated percutaneous vertebroplasty for refracture of cemented vertebrae. Arch Orthop Trauma Surg. 2011;131(7):927-933.

[21] 谢继平. PVP与PKP治疗老年骨质疏松性压缩性骨折早期缓解疼痛的效果对比[D].河北医科大学,2015.

[22] Nagad P, Rawall S, Kundnani V, et al. Postvertebroplasty instability. J Neurosurg Spine. 2012;16(4):387-393.

[23] 何保玉,刘宝戈,李学民,等.骨水泥弥散容积率在骨质疏松性椎体压缩骨折PKP术后疗效评价中的应用[J]. 中国骨与关节杂志, 2016,15(1):68-73.

[24] 丁惠宇,夏建龙. PVP、PKP治疗胸腰椎骨质疏松性压缩骨折的疗效评价标准研究进展[J].山东医药,2014,54(14):101-103.

[25] 张玉忠.老年骨质疏松性脊柱压缩骨折治疗进展[J].中国老年学杂志,2014,34(18):5316-5318.

[26] 卢昌怀,刘志军,张宏波,等.骨水泥量及分布对椎体成形术后相邻椎体生物力学影响的三维有限元分析[J]. 中国骨质疏松杂志, 2015,21(1):29-33.

[27] Matsumoto T, Ohnishi I, Bessho M, et al. Prediction of vertebral strength under loading conditions occurring in activities of daily living using a computed tomography-based nonlinear finite element method. Spine. 2009;34(14):1464-1469.