经皮椎体后凸成形术与非手术治疗急性和亚急性骨质疏松性椎体压缩性骨折临床研究  

Clinical study of acute and subacute osteoporotic vertebral compression fractures with percutaneous kyphoplasty and conservative treatment

作　　者：谢恩[1] 郝定均[1] 

机构地区：[1]西安交通大学附属西安市红十字会医院脊柱外科,陕西710054

出　　处：《创伤外科杂志》2011年第6期510-514,共5页Journal of Traumatic Surgery

基　　金：国家自然科学基金(81100930)

摘　　要：目的经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)与非手术疗法治疗骨质疏松性椎体压缩性骨折(osteoporotic vertebral compression fractures,OVCF),探讨其有效性和安全性仍然不明朗。方法164例骨质疏松性脊柱骨折患者被纳入前瞻性随机对照研究中。2周以内的急性患者和发生在2～8周内的亚急性患者被随机分为非手术治疗组和PKP治疗组。术后观察症状改善情况、椎体高度恢复率、后凸矫正率、骨水泥渗漏情况、疼痛、生理与心理结果。视觉模拟量表(VAS)评定疼痛的程度;健康调查简表(SF-36)和生理、心理调查表(Dallas问卷调查表)测试评估生理和心理变化。结果 2007年7月～2010年7月,164例骨质疏松性椎体压缩骨折患者采用PKP技术(PKP组)与非手术治疗法(非手术治疗组)治疗,PKP组77例,男性47例,女性30例;年龄57～77岁,平均67岁;非手术治疗组87例,男性43例,女性44例;年龄60～82岁,平均67岁。从初诊到3个月随访时两组组内的VAS缓解程度相当,PKP组术前VAS 7.7降至1.8,组内差异显著(P<0.05)。PKP组在术后12～24小时内疼痛显著缓解(P<0.05);术前VAS疼痛评分7.70±1.00,术后24小时VAS评分1.80±0.91,组内差异显著(P<0.05)。椎体前壁高度平均恢复27.90%(P<0.05)。椎体后凸角平均矫正12.60°(P<0.05)。结论 PKP改善了急性和亚急性骨质疏松性椎体压缩骨折患者的生活质量,减轻了腰背痛和残障程度。Objective To compare the efficiency and safety of percutaneous kyphoplasty（PKP） and conservative treatment in treating osteoporotic vertebral compression fractures.Methods There were 164 patients with osteoporotic vertebral compression fractures.Acute patients whose osteoporotic fractures occurred within 2 weeks and sub-acute patients within 2 to 8 weeks were randomly divided into the conservative treatment group and PKP group.Improvement of symptoms,vertebral height restoration rate,correction rate of kyphosis,bone cement leakage,pain,physical and psychological results were observed.Visual analog scale was applied to assess the degree of pain;SF-36 form and the Dallas questionnaire were used to evaluate the physiological and psychological changes.Results In the PKP group,there were 77 cases,including 47 males and 30 females,aging 57-77 years（average 67 years）;while in the conservative treatment group,there were 87 cases,including 43 males and 44 females,aging 60-82 years（average 67 years）.The initial and 3 month follow-up showed a considerable degree of pain relief in both groups from Jul.2007 to Jul.2010（P0.05）.Visual analog scale decreased from 7.70 to 1.80,indicating significant difference（P0.05）.Pain relief was remarkable within 12-24 hours after surgery in PKP group（P0.05）.The preoperative VAS pain score was 7.70±1.00,compared with VAS score of 1.80±0.91 at 24 hours after operation（P0.05）.The average anterior vertebral body height restored by 27.90%（P0.05）.The average correction rate of vertebral kyphosis was 12.60 °（P0.05）.Conclusion Osteoporotic vertebral compression fracture could rapidly acquire pain release,restore height of vertebral body and improve abnormality by means of PKP.

关 键 词：骨质疏松 脊柱骨折 椎体成形术 

分 类 号：R681.5[医药卫生—骨科学]