Tassemeier Tjark, Haversath Marcel, Schutzbach Moritz, Jäger Marcus
Department of Orthopedics and Trauma Surgery, University of Duisburg-Essen, Essen, Germany.
J Craniovertebr Junction Spine. 2018 Oct-Dec;9(4):232-237. doi: 10.4103/jcvjs.JCVJS_55_18.
Osteoporotc fractures with posterior wall injury are commonly treated with a pedicle srcrew instrumentation (PSI) or a ballonkyphoplasty (BKP). A predictor for complications for these patients is the American Society of Anesthesiologists (ASA) class. Clinical results in ASA II/III patients who underwent BKP and PSI due to OF were evaluated to find the optimal treatment regimen.
In a retrospective study design, ASA Class II and III patients with OF type OF 2 and OF 3 according to the German Society of Orthopedics and Trauma Surgery classification who underwent surgery between 2011 and 2016 were enrolled. Perioperative data such as time of surgery, cement leakage, adjacent level fractures, screw loosening, wound infections, and segmental kyphosis correction were measured and a statistical analysis was conducted.
Ninety-nine patients met the inclusion criteria, 17 were classified as ASA II and 82 patients were classified as ASA III. Twenty-eight individuals were treated by PSI, whereas 71 underwent BKP. Not only a longer average operation (120 min) and hospital stay (21 days) were documented in the PSI group but also a better kyphosis correction (7.5°). In comparison, the BKP group required an average operation time of 35.5 min with a mean kyphosis correction of 2.1°. A statistical analysis revealed the surgical procedure and not the ASA class to be a relevant factor for complication and revision surgery.
BKP is a safe and effective therapy including also fractures with posterior wall defects while PSI showed advantages in restoring the sagittal realignment but higher complication and revision risk.
伴有后壁损伤的骨质疏松性骨折通常采用椎弓根螺钉内固定术（PSI）或球囊后凸成形术（BKP）进行治疗。这些患者并发症的一个预测因素是美国麻醉医师协会（ASA）分级。对因骨质疏松性骨折接受BKP和PSI治疗的ASA II/III级患者的临床结果进行评估，以找到最佳治疗方案。
采用回顾性研究设计，纳入2011年至2016年间根据德国骨科与创伤外科学会分类接受手术的ASA II级和III级、OF类型为OF 2和OF 3的骨质疏松性骨折患者。测量手术时间、骨水泥渗漏、相邻节段骨折、螺钉松动、伤口感染和节段性后凸矫正等围手术期数据，并进行统计分析。
99例患者符合纳入标准，其中17例为ASA II级，82例为ASA III级。28例接受PSI治疗，71例接受BKP治疗。PSI组不仅记录到平均手术时间更长（120分钟）和住院时间更长（21天），而且后凸矫正效果更好（7.5°）。相比之下，BKP组平均手术时间为35.5分钟，平均后凸矫正为2.1°。统计分析显示，手术方式而非ASA分级是并发症和翻修手术的相关因素。
BKP是一种安全有效的治疗方法，包括后壁缺损的骨折，而PSI在恢复矢状位对线方面具有优势，但并发症和翻修风险更高。
