Department of Orthopedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
Acta Orthop Traumatol Turc. 2021 Jan;55(1):22-27. doi: 10.5152/j.aott.2021.20045.
This study aimed to compare the clinical and radiological results of percutaneous mesh-container-plasty (PMCP) versus percutaneous kyphoplasty (PKP) in the treatment of osteoporotic thoracolumbar burst fractures.
A prospective study of 122 patients with osteoporotic thoracolumbar burst fractures was conducted. The patients were nonrandomly assigned to receive PKP (62; 16 men, 46 women) and PMCP (60; 14 men, 46 women). The epidemiological data, surgical outcomes, and clinical and radiological features were compared between the 2 groups. Cement leakage, height restoration, deformity correction, canal compromise, and cement distribution were calculated from the radiographs. Visual pain analog scale (VAS), the Oswestry disability index (ODI), and short-form 36 health survey domains role physical (SF-36 rp) and bodily pain (SF-36 bp) were calculated before surgery and immediately and 2 years after surgery.
Although VAS, ODI, SF-36 bp, and SF-36 rp scores improved from 7 (6-9), 71.28±16.38, 22 (0-32), and 25 (0-50) preoperatively to 2 (1-3), 20.02±8.97, 84 (84-84), and 75 (75-100) immediately postoperatively in the PMCP group (p<0.05) and from 7 (6-8), 71.40±13.52, 22 (10.5-31.75), and 25 (0-50) preoperatively to 2 (1-3), 21.78±11.21, 84 (84-84), and 75 (75-100) immediately postoperatively in the PKP group (p<0.05), there was no difference between the 2 groups. The mean cost in the PKP group was less than that in the PMCP group ($5109±231 vs. $6699±201, p<0.05). Anterior, middle, and posterior vertebral body height ratios in the PMCP group were greater than those in the PKP group postoperatively (88.44%±3.76% vs. 81.10%±11.78%, 86.15%±3.50% vs. 82.30%±11.02%, and 93.91%±3.01% vs. 91.43%±6.71%, respectively, p<0.05). The Cobb angle in the PMCP group was lower than that in the PKP group postoperatively (6.67°±4.39° vs. 8.99°±4.06°, p<0.05). Cement distribution in the PMCP group was higher than that in the PKP group (30.48%±5.62% vs. 27.18%±4.87%, p<0.05). Cement leakage was observed to be lesser in the PMCP group (2/60) than in the PKP group (10 vs. 62, p<0.05).
Both PKP and PMCP treatments seem to have significant ability in pain relief and functional recovery. Despite its higher cost, PMCP treatment may have a better inhibition ability of cement leakage, cement distribution, height restoration, and improvement in segmental kyphosis than PKP treatment for osteoporotic thoracolumbar burst fractures.
Level II, Therapeutic Study.
本研究旨在比较经皮网袋成形术（PMCP）与经皮椎体后凸成形术（PKP）治疗骨质疏松性胸腰椎爆裂骨折的临床和影像学结果。
前瞻性研究了 122 例骨质疏松性胸腰椎爆裂骨折患者。患者被非随机分配接受 PKP（62 例；男 16 例，女 46 例）和 PMCP（60 例；男 14 例，女 46 例）治疗。比较两组的流行病学数据、手术结果和临床影像学特征。从 X 线片上计算出水泥渗漏、高度恢复、畸形矫正、椎管狭窄和水泥分布。术前、术后即刻和术后 2 年分别计算视觉疼痛模拟量表（VAS）、Oswestry 功能障碍指数（ODI）以及健康调查简表 36 项维度的角色躯体（SF-36 rp）和躯体疼痛（SF-36 bp）评分。
虽然 PMCP 组的 VAS、ODI、SF-36 bp 和 SF-36 rp 评分从术前的 7（6-9）、71.28±16.38、22（0-32）和 25（0-50）改善至术后即刻的 2（1-3）、20.02±8.97、84（84-84）和 75（75-100）（p<0.05），PKP 组的 VAS、ODI、SF-36 bp 和 SF-36 rp 评分从术前的 7（6-8）、71.40±13.52、22（10.5-31.75）和 25（0-50）改善至术后即刻的 2（1-3）、21.78±11.21、84（84-84）和 75（75-100）（p<0.05），但两组之间没有差异。PKP 组的平均费用低于 PMCP 组（5109±231 美元 vs. 6699±201 美元，p<0.05）。PMCP 组术后前、中、后椎体高度比大于 PKP 组（88.44%±3.76% vs. 81.10%±11.78%、86.15%±3.50% vs. 82.30%±11.02%和 93.91%±3.01% vs. 91.43%±6.71%，均 p<0.05）。PMCP 组术后 Cobb 角低于 PKP 组（6.67°±4.39° vs. 8.99°±4.06°，p<0.05）。PMCP 组的水泥分布高于 PKP 组（30.48%±5.62% vs. 27.18%±4.87%，p<0.05）。PMCP 组的水泥渗漏发生率低于 PKP 组（2/60 例 vs. 10/62 例，p<0.05）。
PKP 和 PMCP 治疗似乎都具有显著的止痛和功能恢复能力。尽管费用较高，但 PMCP 治疗在抑制水泥渗漏、水泥分布、高度恢复和改善骨质疏松性胸腰椎爆裂骨折的节段后凸畸形方面可能比 PKP 治疗具有更好的能力。
二级，治疗性研究。
