文章摘要

胸腰段形态及术式选择对骨质疏松性椎体压缩性骨折的疗效评价

作者: 1洪海东, 1邱承玺
1 上海市嘉定区中医医院骨科,上海 201800
通讯: 邱承玺 Email: llqcx1984@sina.com
DOI: 10.3978/j.issn.2095-6959.2020.09.031

摘要

目的:研究胸腰段形态及不同术式对治疗单节段胸腰椎骨质疏松性压缩性骨折疗效的影响。方法:回顾2012年1月至2016年6月在上海市嘉定区中医医院骨科行经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)/经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗胸腰椎骨质疏松性压缩性骨折患者,根据术前胸腰椎后凸角大小,将研究对象分为胸腰交界无后凸组(non-thoracic junctional kyphosis group,Non-TJK group;术前T10~L2<20°)与后凸组(thoracic junctional kyphosis group,TJK group;术前T10~L2≥20°),评估对比矢状位参数及相应临床疗效。结果:本研究共计纳入65例患者,男21例,女44例;年龄为62.87±5.58岁;随访时间为14.32±2.01个月。TJK组术前椎体楔形角(24.68°±2.51° vs 15.08°±1.27°,P<0.001),TLK(26.08°±2.36° vs 15.25°±1.46°,P<0.001)以及SVA(31.92°±5.41° vs 25.25°±1.84°,P<0.001)显著大于Non-TJK组。末次随访时,TJK组椎体楔形角,TLK及SVA仍大于Non-TJK组,两组的VAS评分及ODI评分均较术前明显改善,但TJK组劣于Non-TJK组,差异有统计学意义。末次随访时,PVP组的椎体楔形角(9.40°±2.63° vs 6.90°±1.16°,P<0.001)和TLK(9.77°±3.25° vs 7.90°±1.21°,P<0.001)显著大于PKP组,且在远期疗效上较之PKP组略差。结论:术前胸腰段后凸角过大更易导致远期背部疼痛症状残留,PKP较PVP能更好恢复椎体形态,减少局部后凸角,在远期疗效更有优势。
关键词: 骨质疏松椎体压缩性骨折;矢状位参数;胸腰交界后凸;经皮椎体后凸成形术;经皮椎体成形术;远期疗效

Efficacy of thoracolumbar morphology and surgical methods on osteoporosis vertebral compressive fracture

Authors: 1HONG Haidong, 1QIU Chengxi
1 Department of Orthopedics, Shanghai Chinese Medicine Hospital of Jiading District, Shanghai 201800, China

CorrespondingAuthor: QIU Chengxi Email: llqcx1984@sina.com

Abstract

Objectives: To investigate the efficacy of thoracolumbar morphology and different surgical methods on the treatment of single segment osteoporotic thoracolumbar compression fracture. Methods: We retrospectively collected patients with osteoporotic thoracolumbar compression fracture who was performed percutaneous kyphoplasty (PKP)/percutaneous vertebroplasty (PVP) in the orthopedics department of our hospital from January 2012 to June 2016. Furthermore, the subjects were classified into non-thoracic Junctional Kyphosis group (Non-TJK group) according to the size of preoperative thoracoluminal kyphosis angle (preoperative T10-L2<20°) and thoracic Junctional Kyphosis Group (TJK group; preoperative T10-L2 20° or higher), and the sagittal parameters and clinical efficacy were evaluated and compared. Results: We included 65 patients in the study (21 males and 44 females), with an average age of 62.87±5.58 years and an average follow-up time of 14.32±2.01 months. The wedge angle (24.68°±2.51° vs 15.08°±1.27°, P<0.001), TLK (26.08°±2.36° vs 15.25°±1.46°, P<0.001) and SVA (31.92°±5.41° vs 25.25°±1.84°, P<0.001) in TJK group were significantly higher than those in non-TJK group. At the final follow-up, the wedge angle, TLK and SVA of TJK group were still larger than those of non-TJK group. The VAS score and ODI score of the two groups were significantly improved postoperatively, but the value in TJK group was larger than that of non-TJK group with statistical difference. At the final follow-up, the wedge angle (9.40°±2.63° vs 6.90°±1.16°, P<0.001) and TLK (9.77°±3.25° vs 7.90°±1.21°, P<0.001) of PVP group were significantly higher than those of PKP group, and the long-term efficacy was slightly worse than that of PKP group. Conclusion: It is more likely to cause long-term residual back pain symptoms if the preoperative TLK is too large. PKP is better than PVP in restoring the shape of vertebral body, reducing the local kyphosis angle, and has more advantages in the long-term efficacy.
Keywords: osteoporosis vertebral compressive fracture; sagittal alignment; thoracolumbar kyphosis; percutaneous kyphoplasty; percutaneous vertebroplasty; long-term efficacy