经皮椎体成形术和经皮椎体后凸成形术治疗不同压缩程度骨质疏松性椎体骨折疗效的比较  

Percutaneous vertebroplasty versus percutaneous kyphoplasty for osteoporotic vertebral compression fractures with different compression levels

作　　者：庄澄宇[1] 陈哲[1] 宋艳艳[2] 曹鹏[1] 梁裕[1] 张兴凯[1] 吴文坚[1] 郑涛[1] 郑月焕[1] 周泽著[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院骨科,上海市伤骨科研究所,200025 [2]上海交通大学医学院统计学教研室

出　　处：《中华创伤骨科杂志》2013年第9期773-777,共5页Chinese Journal of Orthopaedic Trauma

基　　金：上海市科学技术委员会生物医药及临床重大项目（10dz1950400）;上海市卫生局重点科研项目（2011018）;上海市卫生局优秀学科带头人培养项目（新百人计划）（XBR2011024）

摘　　要：目的比较经皮椎体成形术（PVP）和经皮椎体后凸成形术（PKP）治疗骨质疏松性椎体压缩性骨折（OVCF）的疗效及不可压缩程度下对脊柱楔形角和后凸角的纠正，为不同压缩程度下最佳术式的选择提供依据。方法选取2004年4月至2010年1月治疗的123例OVCF患者，分别采用PVP治疗（60例）和｜）KP治疗（63例），两组患者基线学数据比较差异均尤统计学意义（P〉0．05），具有可比性。根据Genant等的方法，将所有患者压缩椎体分为轻度（A级）、中度（B级）和重度（C级）压缩，评价术前、术后视觉模拟坪分（VAS）、楔形角、后凸角的改善情况及两种术式的效果。比较不同压缩等级下两种术式间VAS评分、楔形角、后凸角的改善。结果所台患者术后VAS评分均明硅改善，楔形角、后凸角均矫止，筹并均钉统计学意义（P〈0．05）；两种术式对VAS评分改善比较差异尤统计学意义（P〉0．05）；PKI，对楔形角和后凸角的矫正效果优于PVP，差异均行统计学差异（P〈0．05）。不同胝缩氍度下的患者两种术式问的VAS评分改善比较差异均无统计学意义（P〉0．05）；A、B级忠并两种术式楔形角和后凸角的矫正比较差异均无统计学意义（P〉0．05）；但C级患者中PKP组楔形角和后凸角的矫正均优于PVP纰，差异有统计学意义（P〈0．05）。结论PKP和PVP都能明显缓解OVCFs患荇的疼痛，纠止楔肜角和后凸角，恢复脊柱全长的生理曲度。但PKP能更好地纠正楔形角和后凸角，尤其是在重度瓜缩骨折情况下。Objective To compare percntaneous vertebroplasty （PVP） and percutaneous kypho- plasty （PKP） fi^r kyphotic angle correction in tile treatment of osteoporotic vertebral compression fractures （OVCFs）. Methods From April 2004 to January 2010, 123 OVCF patients received one-segment PVP （60 cases） or PKP （63 cases） in our department. The 2 groups were comparable in baseline characteristics （ P 〉 O. 05） . According to Ge,mnt＇ s melhod, we classified the compressed vertebrae into mildly deformed （group A）. moderately deformed （group B） and severely deformed ones （group C） on the basis of anterior and/or intermediate heighls on the posteroanterior X-ray films. The improvemenls in the visual analog scale （VAS）, corrections of the wedge angle （the angle between superior endplate and inferior endplate at the fractured vertebra） and the kyphotic angle （the angle measured above and below fractured vertebra） made byPVP and PKP in the 3 different compression levels （groups A, B and C） were analyzed and compared. Results All the patients achieved a significant improvement in VAS and significant corrections of the wedge angle and the kyphotic angle after operation （ P 〈 0. 05 ） . There was no significant difference between PVP and PKP in the improvement in VAS （ P 〉 0.05 ）. PKP was significantly better than PVP in the corrections of wedge angle and kyphotic angle （ P 〈 0. 05）. There were no significant differences between PVP and PKP in all the 3 groups regarding the improvement in VAS （ P 〉 0. 05 ） . There were no significant differences re- garding the corrections of wedge angle and kyphotic angle in groups A and B between PVP and PKP （ P 〉 0.05 ）, but PKP was significantly better than PVP regarding the corrections of wedge angle and kyphotic angle in group C （ P 〈 0. 05） . Conclusions Both PKP and PVP can significantly correct the wedge and kyphotic angles, restore the physiological curve of the spine, and relieve the pain of the patient

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]