| Objective:To compare the clinical effects of minimally invasive pedicle screw internal fixation and percutaneous kyphoplasty(PKP)in the treatment of osteoporotic vertebral compression fractures(OVCF).Methods:Eighty patients with OVCF admitted between January 2010 and January 2019 were included as the study subjects.The patients were divided into minimally invasive pedicle screw internal fixation group(group A)and PKP group(group B),according to different surgical methods,with 40 patients in each group.All operations were performed by the Spinal Surgery Group of the Orthopedics Department of the First Affiliated Hospital of Hebei North University.Visual analogue score(VAS)was used to evaluate the pain degree of patients at different time points before and after treatment(preoperative,postoperative 1 day,3 months,6months,12 months).The vertebral compression rate and the change of sagittal Kyphotic Angle of the affected vertebrae were calculated by X-ray examination results at different time points(preoperative,postoperative 1day,3 months,6 months and 12 months).The duration of operation,length of hospital stay and hospitalization cost were compared between the two groups.To comprehensively evaluate the clinical efficacy of the two surgical methods in the treatment of OVCF.Results:(1)VAS score: VAS score in group A was 8.58 ± 0.96 preoperatively,4.53±1.76 1 day after surgery,3.15±0.70 3 months after surgery,3.13±0.65 6 months after surgery,and 3.13± 1.45 12 months after surgery.The VAS score of group B was 8.68±1.04 before surgery,3.33±1.72 at 1 day after surgery,3.45±0.64 at 3 months after surgery,3.85±0.80 at 6 months after surgery,and 4.28±1.65 at 12 months after surgery.There was no statistical significance in the preoperative VAS scores between the two groups(P > 0.05).The VAS score of group B on the first day after surgery was lower than that of group A,and the difference was statistically significant(P < 0.01).The VAS scores of group A at 3,6 and 12 months after surgery were lower than those of group B at 3,6 and 12 months after surgery,and the difference was statistically significant(P < 0.05),that is,the two surgical methods had different pain relief degrees.(2)ODI score: The ODI score of group A was 73.10±4.95 preoperatively,54.60± 9.76 1 day after surgery,26.35± 5.14 3 months after surgery,24.85 ± 3.61 6 months after surgery,and 21.65 ± 3.60 12 months after surgery.The preoperative ODI score of group B was 72.30±5.01,32.00±9.87 one day after surgery,33.70±4.68 three months after surgery,32.70±3.64 six months after surgery and 31.70±4.69 12 months after surgery.There was no statistical significance in preoperative ODI scores between the two groups(P > 0.05).ODI score in group B on the first day after surgery was lower than that in group A on the first day after surgery,the difference was statistically significant(P < 0.01),that is,functional recovery of patients in group B was significantly improved after surgery;VAS scores in group A at 3,6 and 12 months after surgery were lower than those in group B at 3,6 and 12 months after surgery,and the difference was statistically significant(P < 0.05),that is,there were differences in the degree of functional recovery of patients at different time points after surgery between the two methods.(3)Vertebral anterior edge compression rate: in group A,the anterior edge compression rate was 42.60±8.23% before surgery,11.58±5.01% 1 day after surgery,10.85±4.63%3 months after surgery,10.75±4.44% 6 months after surgery,and 10.85±4.22% 12 months after surgery.In group B,the anterior vertebral margin compression rate was 41.45±7.41% before surgery,16.60±5.10% one day after surgery,20.05±5.13% three months after surgery,20.10±4.86%six months after surgery,and 20.20±4.93% 12 months after surgery.There was no significant difference in anterior vertebral compression rate between the two groups before surgery(P > 0.05).Compared with group B,the anterior edge compression rate of group A was lower at each time point(1d,3 months,6 months and 12 months)after surgery,and the difference was statistically significant(P < 0.01),that is,the recovery of the compression rate of the affected vertebra was different between the two groups.(4)Kyphotic Angle of diseased vertebrae: in group A,31.58 ±8.92° before surgery,9.50±3.20° 1 day after surgery,110.15±3.53°3 months after surgery,10.53±3.93° 6 months after surgery,10.95±4.22 ° 12 months after surgery;Group B was 32.45 ± 8.11 ° before surgery,14.40±3.91° 1 day after surgery,16.65±4.34° 3 months after surgery,16.25±4.16° 6 months after surgery,and 15.25±4.05° 12 months after surgery.There was no significant difference in Kyphotic Angle between the two groups before surgery(P > 0.05).Kyphotic Angle of the disaffected vertebra in group A was smaller than that in group B at each time point(1d,3 months,6 months and 12 months),and the difference was statistically significant(P < 0.01),that is,the recovery of Kyphotic Angle of the disaffected vertebra was different between the two groups.(5)Complications: There were no intraoperative complications in group A,and there were 7 cases of bone cement leakage in group B,but no clinical symptoms.In the long-term follow-up after operation,3 patients in group A had backache after operation,and 2 patients had pedicle screw loosening.In group B,there were 6 cases of residual lumbago and back pain,and 3cases of postoperative vertebral refracture.(6)The operative duration of group A was 75.18 ± 11.65 min longer than that of group B,51.55 ±8.18 min,and the difference was statistically significant(P < 0.01).The length of hospitalization in group A was 7.85±1.41 d longer than that in group B,4.25±1.58 d longer,the difference was statistically significant(P< 0.01).Conclusion: Both operations have achieved good results in the treatment of OVCF patients.Both operations can relieve the pain of patients,and can effectively restore the height of the affected vertebra and correct the kyphosis deformity.PKP has obvious quick analgesic effect in the early stage,but in the long-term patients,intractable low back pain,adjacent vertebral fracture and other problems should be vigilant.On the other hand,minimally invasive pedicle internal fixation was less effective than PKP in immediate pain relief,but patients had fewer long-term complications and guaranteed quality of life. |
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