| Objective: The clinical and imaging effects of PKP surgery and PPSF surgery in the treatment of osteopenic thoracolumbar VCFs were compared and analyzed.Methods: 66 patients with osteopenic VCFs who had undergone PKP or PPSF surgeries in our medical center,and met the inclusion and exclusion criteria were reviewed retrospectively,from January 2018 to March 2019.All patients were divided into PKP group(n=35,included 12 male patients and 23 female patients,aged between 60 ～ 65 years old,with an average of 63.2～3.0 years old.The specific injury mechanisms included13 cases of high fall injury,12 cases of fall injury,7 cases of traffic accident injury and 3 cases of no inducement)and PPSF group(n=31,included 11 male patients and 20 female patients,aged between 60 ～ 63 years old,with an average age of 62.5 ～ 3.1 years.The specific injury mechanism included 14 cases of high fall injury,10 cases of fall injury and7 cases of traffic accident injury)according to the operation method performed.The perioperative related indexes such as blood lose,operation time,bedtime after surgery and hospitalization period were recorded and compared between two groups.The clinical indicators such as VAS scores,ODI index,imaging indicators such as anterior height of injured vertebrae(AH),anterior height ratio of injured vertebrae(AHR),height restoration of injured vertebrae(HR)and kyphosis angle(KA)were recorded and compared between two groups in different time points.The time of bone fusion in PPSF group was recorded and followed up.Results: General information such as age,gender,BMD in PKP group and PPSF group was found no statistical difference.The blood loss 、operative time、postoperative-bedtime、hospitalization-period in PKP group were lower than those in PPSF group [(12.8±6.0)m L vs(67.2±6.0)m L、(30.2±2.8)min vs(93.5±8.5)min、(1.3～0.5)days vs(1.7～0.8)days、(4.1～0.6)days vs(5.0～0.8)days ].The postoperative VAS socres,ODI index and anterior height of injured vertebrae(AH)in both groups were better than those before operation [ PKP group:(2.4±0.9)vs(5.2±0.9)、(21.00±2.58)vs(67.61±4.30)、(22.1～1.8)mm vs(13.68～2.58)mm;PPSF group:(2.8±0.9)vs(4.9±0.9)、(28.67±2.89)vs(69.31±3.27)、(21.4～1.0)mm vs(13.8～2.6)mm].The VAS and ODI in PPSF group were higher than those in PKP group 3 days after operation [(2.8±0.9)vs(2.4±0.9)、(28.67±2.89)vs(21.00±2.58)],however,at the 1 month after operation and the final follow-up there was no obvious difference between two groups(P>0.05).In each time point no statistical difference in AH and HR were found between two groups.AHR in PPSF group was higher than that in PKP group after operation [(92.15～3.77)vs(88.37～6.61)、(91.43～4.65)vs.(87.35～4.23)、(91.17～4.16)vs(87.33～6.98)].The KA of PPSF group was lower than PKP group after operation and at final follow-up[(6.4～1.7)vs(8.2～2.4)、(6.6～3.5)vs.(8.3～2.5)、(6.6～1.7 vs8.3～2.5)].As for complications,no obvious difference was found between two groups(P>0.05).All patients in PPSF group achieved bony healing at the final follow-up,with a mean fusion time of 3.84 ± 0.72 months.Conclusions: Both PKP and PPSF can achieve satisfactory clinical effects in osteopenic VCF.Although PKP has better clinical effects than PPSF in the short term,the latter one has better long-term effects,including correction of kyphosis and preservation of vertebral body height and gets bony fusion. |
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