经皮穿刺脊柱后凸成形术治疗新鲜和陈旧骨质疏松性椎体压缩骨折的临床效果比较  

Comparison of the clinical effect of percutaneous kyphoplasty in the treatment of acute and chronic osteoporotic vertebral fractures

作　　者：马玉泉[1] 周建伟[1] 迟成 MA Yu-quan;ZHOU Jian-wei;CHI Cheng(Department of Orthopedics,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院骨科

出　　处：《中国医刊》2020年第1期56-60,共5页Chinese Journal of Medicine

摘　　要：目的探讨经皮穿刺脊柱后凸成形术(percutaneous kyphoplasty,PKP)治疗新鲜和陈旧骨质疏松性椎体压缩骨折的临床疗效。方法选取2012年5月至2015年12月在北京同仁医院行PKP治疗的骨质疏松性胸腰椎压缩性骨折患者122例,术前常规采用MRI评估骨折的新鲜程度,将患者分为新鲜骨折组(99例)和陈旧骨折组(23例)。两组患者均于术前、术后1周及术后12个月行X线检查,测量椎体高度及椎体后凸角度,并采用视觉模拟量表(visual analogue scale,VAS)评分和Oswestry功能障碍指数(Oswestry disability index,ODI)对术后疼痛改善情况及日常生活功能进行评估。结果所有患者手术均顺利完成,无血管神经损伤等严重并发症,术后随访12~34个月,平均(15.5±5.2)个月。两组患者术后1周、12个月椎体前壁、中间、后壁高度及后凸角度均明显大于术前,且新鲜骨折组明显大于陈旧骨折组,差异有显著性(P<0.05)。两组患者术后1周、12个月时VAS评分及ODI均明显低于术前,差异有显著性(P<0.05),术后1周时新鲜骨折组VAS评分及ODI明显低于陈旧骨折组,差异有显著性(P<0.05),至术后12个月时两组VAS评分及ODI比较差异无显著性(P>0.05)。结论 PKP治疗新鲜骨质疏松性椎体压缩骨折的临床疗效优于陈旧骨折,能较好地恢复椎体高度及矫正后凸角度,有效缓解疼痛,提高患者的生活质量。Objective To explore the clinical efficacy of percutaneous kyphoplasty(PKP)in the treatment of acute and chronic osteoporotic vertebral compression fractures. Method From May 2012 to Dec 2015, 122 patients with osteoporotic vertebral compression fractures(OVCF) were recruited with PKP. Evaluation of fracture freshness was performed by routine preoperative magnetic resonance imaging(MRI). All patients were divided into 2 groups: acute fracture group(n=99) and chronic fracture group(n=23). The mean duration of follow-up was 15.5 months(ranging 12 to 34 months). All patients were received X-ray before and after PKP and 12 months after surgery during the follow-up period. According to preoperative and postoperative plain standing lateral radiographs, to estimate vertebral height and kyphotic angle, the postoperative vertebral height restoration and kyphotic angle correction were analyzed. The therapeutic effects was assessed by visual analogue scale(VAS) and Oswestry disability index(ODI) at 1 d before surgery and 1 w,12 month after surgery. Result All surgical precedures were finished safely. No complication such as blood vessels, nerve damage was noted. The restoration rates for 1 week, anterior, middle and posterior vertebral height and kyphotic angle for 1 week and 12 months after operation were statistically improved in both groups(P<0.05 or 0.01), the acute fracture group for 1 week after operation was obvious(P<0.05 or 0.01). The scores of VAS and ODI for 1 week and 12 months after operation were significantly lower than those before operation(P<0.05 or 0.01);The acute fracture group was more obvious(P<0.05). There was no statistical difference on the socres of VAS and ODI for 12 months after operation in the two groups(P>0.05). Conclusion The clinical therapeutic effects of PKP in the treatment of acute osteoporotic vertebral fractures were better than the chronic fractures. PKP can effectively improve the vertebral height and kyphotic angle, and relieve the pain and improve the quality of life.

关 键 词：经皮穿刺脊柱后凸成形术 骨质疏松性椎体压缩骨折 新鲜骨折 陈旧骨折 

分 类 号：R683.2[医药卫生—骨科学]