胸腰段重度楔形骨质疏松性椎体压缩骨折的经皮椎体成形术治疗与保守治疗的近期疗效和并发症的比较  

Vertebroplasty versus conservative treatment for severe thoracolumbar wedge-shaped osteoporotic vertebral compression fractures

作　　者：刘振华[1] 张亮[1] 高梁斌[2] 张志[1] 李健[1] 杨波[1] 余博臣[1] 

机构地区：[1]广州医学院第三附属医院骨科,510150 [2]中山大学附属孙逸仙纪念医院骨科

出　　处：《中华创伤骨科杂志》2012年第6期507-512,共6页Chinese Journal of Orthopaedic Trauma

基　　金：基金项目：广东省医学科研基金（A2011276）,广州市医药卫生科技项目（2009-YB-165）

摘　　要：目的比较经皮椎体成形术（PVP）和保守治疗胸腰段重度楔形骨质疏松性椎体压缩骨折（ovcv）的近期疗效及并发症。方法对2007年1月至2010年1月收治的43例胸腰段重度楔形OVCF患者进行前瞻性非随机对照研究，根据患者意愿分别行PVP治疗（19例）和保守治疗（24例）。两组患者治疗前一般资料比较差异均无统计学意义，具有可比性。治疗前、后以视觉模拟评分（VAS）评估疼痛程度，用SF-36健康调查简表（SF-36）评估患者生理功能（PCS）及心理功能（MCS）；并比较两组患者治疗前、后VAS评分、PCS评分、MCS评分、椎体高度、后凸角度及渗漏情况。结果所有患者均完成1年随访，PVP组VAS评分、疼痛缓解率、PCS评分、椎体前中壁高度、后凸角度在治疗后各时间点均优于保守治疗组，差异均有统计学意义（P〈0．05）；PVP组MCS评分在治疗后1个月高于保守治疗组，其他时间点两组MCS评分差异均无统计学意义（P〉0．05）；两组椎体后壁高度及新发椎体骨折发生率差异均无统计学意义（P〉0．05）；但PVP组新发椎体骨折时间比保守治疗组提前约53d，差异有统计学意义（P〈0．05）。PVP组骨水泥渗漏率达52．6％（10／19），椎间盘渗漏占70．O％（7／10），均未引起严重临床并发症。结论PVP治疗胸腰段重度楔形椎体压缩骨折在技术上是可行的，其临床疗效优于保守治疗，且并不增加术后新发椎体骨折的风险。Objective To compare the clinical outcomes of percutaneous vertebroplasty （PVP） and conservative treatment for patients with severe thoracolumbar wedge-shaped osteoporotic vertebral compression fracture （OVCF） . Methods From January 2007 to January 2010, a total of 43 patients with severe thoracolumbar wedge-shaped OVCF were nonrandomly assigned to undergo PVP （19 cases） or conservative treatment （24 cases） according to their own will. The baseline clinical and radiological characteristics in both groups were comparable. Clinical outcomes were determined by pain visual analogue scale（VAS） and short form 36 health survey（SF-36） . Vertebral height, kyphotic angle and cement leakage were assessed by ra- diography while new OVCFs by MRI. Results All the 43 patients obtained a follow-up of at least one year. The PVP group was significantly superior to the conservative group regarding VAS score, physical component summary （PCS） score, anterior and central vertebral heights and kyphotic angle at all postoperative intervals （ P 〈 O. 05）, while no significant differences were found between the 2 groups regarding posterior vertebral height, new OVCF incidence or mental component summary （MCS） score at all postoperative intervals（ P 〉 O. 05） except for the first month after treatment. New OVCFs were found 53 days earlier in the PVP group than in the conservative group, with a significant difference（ P 〈 O. 05） . Asymptomatic cement leakage occurred in 52. 6% （10/19） of the treated vertebrae in PVP group and 70. 0% of them （7 / 10） occurred in the intervertebral disc. Conclusions PVP is technically feasible for treatment of severe thoracolumbar wedge-shaped OVCF in spite of a high rate of asymptomatic leakage. PVP may lead to immediate and sustained pain relief and physical functional improvement, without increasing the risk of new OVCFs, which are significantly greater than what can be achieved by the conservative treatment.

关 键 词：脊柱骨折 骨质疏松 椎体成形术 

分 类 号：R687.3[医药卫生—骨科学]