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骨质疏松性椎体压缩骨折手术治疗的新技术:经椎骨植骨与固定

New Technology for Surgical Treatment of Osteoporotic Vertebral Compression Fractures: The Transvertebral Bone Graft and Fixation.

作者信息

Hou Yang, Shi Guodong, Sun Jingchuan, Shi Jiangang, Xu Guohua, Guo Yongfei, Han Dan

机构信息

Department of Orthopaedic Surgery, Changzheng Hospital, Shanghai, China.

Department of Orthopaedic Surgery, Changzheng Hospital, Shanghai, China.

出版信息

World Neurosurg. 2018 Oct;118:e25-e33. doi: 10.1016/j.wneu.2018.06.074. Epub 2018 Jun 20.

Abstract

OBJECTIVE

To introduce an innovative surgical technique, transvertebral bone graft and augmentation (TBGA), to and evaluate its clinical efficacy in treating osteoporotic vertebral body compression fractures (VCFs), with balloon kyphoplasty (BKP) as a control.

METHODS

A total of 81 patients with a single-level osteoporotic VCF underwent TBGA (n = 38) or BKP (n = 43) at our hospital between October 2012 and January 2015. The average duration of follow-up period was 27.9 months. The patients were evaluated with plain radiography, computed tomography, and magnetic resonance imaging preoperatively, immediately postoperatively, at 3- and 6-month follow-ups, and every 6 months thereafter. Clinical status was assessed using the Oswestry Disability Index (ODI) and a visual analog scale (VAS). In addition, parameters of anterior vertebral body height (AVBH), kyphosis angle (KA), adjacent segment degeneration (ASD), and complications were also compared between the 2 groups.

RESULTS

Significant clinical improvements in ODI, VAS scores, AVBH, and KA were seen in both the TBGA and BKP groups after surgery (P < 0.05). However, the differences in improvements in ODI and VAS between the TBGA and BKP groups were not statistically significant (P > 0.05). The improvements in AVBH and KA were significantly better in the TBGA group (P < 0.05). Furthermore, the rates of ASD and complications were significantly lower in the TBGA group during the follow-up period (P < 0.05).

CONCLUSIONS

TBGA is an effective and safe surgical technique that appears to be a promising alternative to BKP for the surgical treatment of osteoporotic VCFs.

摘要

目的

介绍一种创新的手术技术——经椎骨植骨与强化术(TBGA),并以球囊后凸成形术(BKP)作为对照,评估其治疗骨质疏松性椎体压缩骨折(VCF)的临床疗效。

方法

2012年10月至2015年1月期间,我院共有81例单节段骨质疏松性VCF患者接受了TBGA(n = 38)或BKP(n = 43)治疗。平均随访时间为27.9个月。术前、术后即刻、术后3个月和6个月以及此后每6个月对患者进行X线平片、计算机断层扫描和磁共振成像评估。使用Oswestry功能障碍指数(ODI)和视觉模拟量表(VAS)评估临床状况。此外,还比较了两组患者的椎体前缘高度(AVBH)、后凸角(KA)、相邻节段退变(ASD)参数及并发症情况。

结果

TBGA组和BKP组术后ODI、VAS评分、AVBH和KA均有显著临床改善(P < 0.05)。然而,TBGA组和BKP组在ODI和VAS改善方面的差异无统计学意义(P > 0.05)。TBGA组在AVBH和KA改善方面明显更好(P < 0.05)。此外,随访期间TBGA组的ASD发生率和并发症发生率显著更低(P < 0.05)。

结论

TBGA是一种有效且安全的手术技术,似乎是BKP治疗骨质疏松性VCF手术的一种有前景的替代方法。

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