微创椎弓根螺钉固定联合经皮椎体成形术预防椎体成形术后继发骨折

Minimally invasive pedicle screw fixation combined with percutaneous vertebroplasty for preventing secondary fracture after vertebroplasty.

作者信息

Gu Yu-Tong, Zhu Dong-Hui, Liu Hai-Fei, Zhang Feng, McGuire Robert

机构信息

Department of Orthopaedics, Zhongshan Hospital of Fudan University, Shanghai, 200032, China.

Department of Orthopaedics, Shanghai Electric Power Hospital, Shanghai, 200050, China.

出版信息

J Orthop Surg Res. 2015 Mar 7;10:31. doi: 10.1186/s13018-015-0172-1.

BACKGROUND

Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) could give rise to excellent outcomes and significant improvements in pain, analgesic requirements, function, cost, and incidence of serious complications for thoracolumbar osteoporotic vertebral compression fractures (VCFs). But some studies showed the recurrent fracture of a previously operated vertebra or adjacent vertebral fracture after PVP or PKP. The purpose of this study was to compare minimally invasive pedicle screw fixation (MIPS) and PVP with PVP to evaluate its feasibility and safety for treating acute thoracolumbar osteoporotic VCF and preventing the secondary VCF after PVP.

METHODS

Sixty-eight patients with a mean age of 74.5 years (ranging 65 ~ 87 years), who sustained thoracic or lumbar fresh osteoporotic VCFs without neurologic deficits underwent the procedure of PVP (group 1, n = 37) or MIPS combined with PVP (group 2, n = 31). Visual analog scale pain scores (VAS) were recorded and Cobb angles, central and anterior vertebral body height were measured on the lateral radiographs before surgery and immediately, 1 month, 2 months, 3 months, 6 months, 1 year, and 2 years after surgery.

RESULTS

The patients were followed for an average of 27 months (ranging 24-32 months). The VAS significantly decreased after surgery in both groups (P < 0.005). The central and anterior vertebral body height significantly increased (P < 0.005), and the Cobb angle significantly decreased (P < 0.05) immediately after surgery in both groups. No significant changes in both the Cobb angle correction and the vertebral body height gains obtained were observed at the end of the follow-up period in group 2. But the Cobb angle significantly increased (P < 0.005), and the central and anterior vertebral body height significantly decreased (P < 0.005) 2 years after surgery compared with those immediately after surgery in group 1, and there were five patients with new fracture of operated vertebrae and nine cases with fracture of adjacent vertebrae.

CONCLUSIONS

MIPS combined with PVP is a good choice for the treatment of acute thoracolumbar osteoporotic VCF, which can prevent secondary VCF after PVP.

背景

经皮椎体成形术（PVP）和经皮后凸成形术（PKP）在治疗胸腰椎骨质疏松性椎体压缩骨折（VCF）方面可产生良好效果，并在疼痛、镇痛需求、功能、成本及严重并发症发生率方面有显著改善。但一些研究显示，PVP或PKP术后会出现先前手术椎体的再骨折或相邻椎体骨折。本研究旨在比较微创椎弓根螺钉内固定术（MIPS）联合PVP与单纯PVP，以评估其治疗急性胸腰椎骨质疏松性VCF及预防PVP术后继发性VCF的可行性和安全性。

方法

68例平均年龄74.5岁（65至87岁）的胸腰椎新鲜骨质疏松性VCF且无神经功能缺损的患者接受了PVP手术（第1组，n = 37）或MIPS联合PVP手术（第2组，n = 31）。记录视觉模拟评分法疼痛评分（VAS），并在术前及术后即刻、1个月、2个月、3个月、6个月、1年和2年时在侧位X线片上测量Cobb角、椎体中心高度和前缘高度。

结果

患者平均随访27个月（24至32个月）。两组术后VAS均显著降低（P < 0.005）。两组术后即刻椎体中心高度和前缘高度均显著增加（P < 0.005），Cobb角显著减小（P < 0.05）。随访期末，第2组Cobb角矫正和椎体高度增加均无显著变化。但与术后即刻相比，第1组术后2年Cobb角显著增加（P < 0.005），椎体中心高度和前缘高度显著降低（P < 0.005），有5例手术椎体新发骨折，9例相邻椎体骨折。