早期与延迟经皮椎体后凸成形术治疗老年椎体压缩性骨折的疗效及1年随访比较  

Comparison of Efficacy and Long-term Follow-up Results between Early and Delayed Percutaneous Kyphoplasty for Vertebral Compression Fractures in the Elderly

作　　者：王中兴 王睿[1] WANG Zhong-xing;WANG Rui(the First Department of Orthopedics,Nanjing Hospital of Integrated Traditional Chinese and Western Medicine,Nanjing University of Chinese Medicine,Nanjing 210014,China)

机构地区：[1]南京中医药大学附属南京市中西医结合医院骨一科,江苏南京210014

出　　处：《中国现代手术学杂志》2018年第5期366-370,共5页Chinese Journal of Modern Operative Surgery

摘　　要：目的探究早期与延迟经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗老年椎体压缩性骨折(osteoporotic vertebral compression fracture,OVCF)的疗效及1年随访差异。方法选取2015年1月至2017年1月间于我院就诊的椎体压缩性骨折的82例老年患者,根据随机数字表法分为观察组(39例)和对照组(43例),分别于伤后1周内及伤后4周行PKP,术后随访12个月,比较两组患者手术情况,手术前后疼痛情况(VAS评分),活动功能(ODI评分),伤椎影像学检查结果(椎体前壁及中线高度压缩率,Cobb角),以及随访期间并发症发生情况。结果两组患者手术时间,术后下地时间及平均住院日比较无统计学差异(P=0. 567,0. 210,0. 386),观察组患者骨水泥注入量显著高于对照组(P=0. 002);两组患者术后VAS评分和ODI评分显著低于手术前(P <0. 001),观察组术后1周及12个月VAS评分低于对照组(P=0. 008,0. 002),两组患者术后ODI评分无统计学差异(P=0. 553,0. 202);两组患者术后椎体前壁高度压缩率,椎体中线高度压缩率及Cobb角显著低于手术前(P <0. 05),观察组上述指标显著低于对照组(P=0. 009,0. 005,<0. 001);术后随访期间,观察组患者相邻椎体畸形率,伤椎再骨折率及平均VAS评分低于对照组(P=0. 028,0. 049,0. 011),两组患者骨水泥外渗率及相邻椎体骨折发生率相比无统计学差异(P=0. 161,0. 612)。结论 OVCF的老年患者接受早期PKP,可以显著减轻患者疼痛,有效恢复椎体外形,降低术后并发症发生率,值得在临床上推广。Objective To investigate the efficacy and long-term follow-up results between early and delayed percutaneous kyphoplasty(PKP)in the treatment of vertebral compression fractures(OVCF)in the elderly. Methods From January 2015 to January 2017,82 elderly patients with vertebral compression fractures who were treated in our hospital were randomly divided into the observation group(39 cases)and the control group(43 cases).They were performed PKP within 1 week and 4 weeks after injury respectively.Both groups were followed up for 12 months.The operation conditions,pre-and post-operative visual analogue scale(VAS),ODI score,imaging results of injured vertebrae and complications during follow-up between the two groups were compared. Results There was no significant difference in operation time,postoperative hospital stay and the average hospitalization stay between the two groups(P=0.567,0.210,0.386).Bone cement injection volume in the observation group was significantly higher than that of the control group(P=0.002).The post-operative VAS score and ODI score of the two groups were significantly lower than the pre-operation ones(P<0.001).The VAS score of the observation group was lower than that of the control group at 1 weeks and 12 months after operation(P=0.008,0.002),and there was no significant difference in ODI score between the two groups after operation(P=0.553,0.202).The compression rate of the anterior vertebral height and the midline vertebral height,and the Cobb angle of the observation group were significantly lower than that of the control group(P=0.009,0.005,<0.001).During the follow-up period,the deformity rate of adjacent vertebrae,re-fracture rate of injured vertebrae and the average VAS score in the observation group were lower than that of the control group(P=0.028,0.049,0.011).There was no significant difference in the cement leakage rate and the incidence of adjacent vertebral fractures between the two groups(P=0.161,0.612). Conclusion Early PKP in elderly patients with OVCF can significantly relieve

关 键 词：胸腰椎骨折 经皮椎体后凸成形术 手术时机 骨质疏松 

分 类 号：R683.2[医药卫生—骨科学]