不同病程的单节段胸腰段严重骨质疏松性椎体压缩性骨折行PKP手术疗效的对比研究  

A comparative study of the efficacy of PKP surgery for severe single segment osteoporotic vertebral compression fractures of thoracolumbar at different periods

作　　者：杨智杰 刘渤[1] 陈杰 夏辉强 张野 韩非 唐盼 YANG Zhi-jie;LIU Bo;CHEN Jie;XIA Hui-qiang;ZHANG Ye;HAN Fei;TANG Pan(Department of Orthopaedics,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院骨科,重庆400016

出　　处：《创伤外科杂志》2020年第12期904-909,共6页Journal of Traumatic Surgery

摘　　要：目的比较不同时期行经皮椎体后凸成形术(PKP)对单节段胸腰段严重骨质疏松性椎体压缩性骨折(VSOVCF)的手术疗效。方法回顾性分析2015年1月—2017年7月重庆医科大学附属第一医院骨科收治的符合纳入标准的106例胸腰段VSOVCF患者的临床资料。按病程长短进行分组:A组病程为1周内(26例);B组病程为1~3周(27例);C组病程为3~6周(26例);D组病程为6周以上(27例)。记录并比较各组患者术前与术后即刻、超过2年末次随访时VAS评分、Oswestry功能障碍指数(ODI)、局部后凸角(LKA)和伤椎高度,术中使用骨水泥体积、术后骨水泥渗漏率及相邻椎体骨折发生率,评估疼痛、功能改善情况和并发症发生情况。结果各组患者年龄、性别、体质指数、骨密度及椎体内裂隙征等术前资料比较,差异均无统计学意义(P>0.05)。各组患者术后即刻和末次随访时VAS评分和ODI均较术前有明显改善(P<0.05),疼痛的改善呈持续性;但末次随访时A、B两组VAS评分[(2.7±0.5)分、(2.8±0.4)分]和ODI[(36.9±4.1)%、(37.8±3.2)%]明显低于C、D两组[VAS评分分别为(3.2±0.7)分、(3.3±0.4)分,ODI分别为(43.4±3.4)%、(44.7±4.6)%],P<0.05;各组LKA和伤椎高度在术后即刻均得到显著矫正,末次随访时C、D两组的伤椎高度[(14.4±1.6)mm、(14.6±1.8)mm]明显低于A、B两组[(16.3±0.9)mm、(16.5±0.9)mm](F=9.841,P=0.000),LKA明显大于A、B两组(P<0.05);B组骨水泥渗漏率(26%)较低,明显低于其余各组且与C、D两组(58%、63%)差异有显著统计学意义(χ^2=8.705,P=0.033);A、B两组相邻椎体骨折的发生率(8%、7%)明显低于C、D两组(31%、26%),差异有统计学意义(χ^2=8.332,P=0.040)。结论不同病程VSOVCF行PKP术后即刻效果相似,病程3周以内的患者在中远期随访获得相对更好的持续效果,3周以后行PKP手术可能会增加骨水泥渗漏和相邻椎体骨折风险。Objective To compare the surgical efficacy of percutaneous kyphoplasty(PKP)for severe single segment thoracolumbar osteoporotic vertebral compression fracture(vsOVCF)at different periods.Methods A total of 106 patients with single segment thoracolumbar vsOVCF who underwent PKP treatment in our hospital from Jan.2015 to Jul.2017 were included into this retrospective study.Patients were divided by disease course,Group A:the course of disease was within 1 week(26 cases),Group B:the course of disease was 2-3 weeks(27 cases),Group C:the course of disease was 3-6 weeks(26 cases),Group D:the course of disease was more than 6 weeks(26 cases).The visual analogue score(VAS),Oswestry dysfunction index(ODI),local kyphosis angle(LKA)before and after surgery,cement volume during operation,cement leakage and adjacent vertebral fractures(AVF)after surgery were observed to assess pain,functional improvement and complications.Results There was no significant difference in preoperative clinical data of age,gender,body mass index,bone mineral density and intravertebral vacuum cleft among the four groups(P>0.05).The postoperative VAS scores and ODI in each group were significantly improved(P<0.05),and the relief in pain was continuous.But the VAS and ODI in Group A[(2.7±0.5)points and 36.9%±4.1%,respectively]and Group B[(2.8±0.4)points and 37.8%±3.2%,respectively]were significantly lower than those in Group C[(3.2±0.7)points and 43.4%±3.4%,respectively]and Group D[(3.3±0.4)points and 44.7%±4.6%,respectively]at the last follow-up,P<0.05;The LKA and vertebral height of each group were significantly corrected immediately after surgery,but at the last follow-up,LKA was significantly larger in Group C and D than those in Group A and B(P<0.05).The height of the injured vertebral in Group C and D[(14.4±1.6)mm and(14.6±1.8)mm,respectively]was significantly lower than those in Group A and B[(16.3±0.9)mm and(16.5±0.9)mm,respectively,F=9.841,P=0.000].The leakage rate of bone cement was lower in Group B(26%),which was significantly d

关 键 词：椎体压缩骨折 骨质疏松 椎体内裂隙征 骨水泥渗漏 椎体成形术 

分 类 号：R683.2[医药卫生—骨科学]