两种术式治疗骨质疏松性椎体压缩骨折临床效果比较  

Clinical Effect of Two Kinds of Surgical Approaches in the Treatment of Osteoporotic Vertebral Compression Fracture

作　　者：韩毅[1] 蔡力[1] 冯枭[1] HAN Yi;CAI Li;FENG Xiao(Department of Orthopedics,the Second People's Hospital of Guangyuan,Guangyuan,Sichuan 628000,China)

机构地区：[1]广元市第二人民医院骨科,四川广元628000

出　　处：《解放军医药杂志》2021年第1期66-70,共5页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：四川省卫生和计划生育委员会科研课题[18PJ073]。

摘　　要：目的研究经皮椎体成形术(PVP)与经皮椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩骨折(OVCFs)对疼痛、围术期情况、疾病相关因子及Oswestry功能障碍指数(ODI)评分的影响。方法回顾性分析2015年2月—2018年2月收治的OVCFs患者84例的临床资料,按手术方法分为PVP组44例和PKP组40例。观察2组术前、术后5 d、3、6、12个月时的疼痛情况。比较2组术前、术后3、6、12个月时的关节功能。比较2组围术期情况。观察2组术前及术后12个月疾病相关因子、生活质量水平。记录2组并发症发生情况。结果 2组术后视觉模拟评分法(VAS)和Oswestry功能障碍指数(ODI)评分均低于术前,且PKP组术后ODI评分低于PVP组(P<0.05,P<0.01)。PVP组术中透视次数少于PKP组,手术时间短于PKP组(P<0.01)。术后12个月,2组Ⅰ型胶原C端异物肽(CTX-Ⅰ)、瘦素水平均较术前显著下降,胰岛素样生长因子(IGF)、睾酮(T)、SF-36各条目水平均较术前显著升高,且PKP组术后CTX-Ⅰ水平低于PVP组,IGF、T、SF-36中健康感觉及躯体健康评分高于PVP组(P<0.05)。2组并发症发生率比较差异无统计学意义(P>0.05)。结论 PVP及PKP治疗OVCFs效果均显著,且能够改善患者疼痛情况,但PKP对腰椎运动功能效果更好,利于患者骨生长及生活质量的提高。Objective To study the effects of percutaneous vertebroplasty(PVP)and percutaneous kyphoplasty(PKP)on pain,perioperative conditions,disease-related factors and Oswestry dysfunction index(ODI)score in patients with osteoporotic vertebral compression fractures(OVCFs).Methods The clinical data of 84 OVCFs patients admitted between February 2015 and February 2018 were retrospectively analyzed.According to surgical methods,they were divided into PVP group(n=44)and PKP group(n=40).The pain before operation and at 5 d,3,6 and 12 months after operation was observed.The joint function of the two groups was compared before operation,and at 3,6 and 12 months after operation.The perioperative conditions of the two groups were compared.Disease-related factors and quality of life of the two groups were observed before and at 12 months after operation.Complications in the two groups were recorded.Results Visual analogue scale(VAS)and Oswestry disability index(ODI)scores of the two groups were both lower than those before surgery,and postoperative ODI scores of the PKP group were lower than those of the PVP group(P<0.05,P<0.01).The number of intraoperative fluoroscopy in PVP group was less than that in PKP group,and the duration of operation was shorter than that in PKP group(P<0.01).At 12 months after surgery,collagen typeⅠthe c-terminal peptide(CTX-Ⅰ),and foreign body leptin levels were significantly reduced,whereas insulin-like growth factor(IGF),testosterone(T),the levels of each item in SF-36 were significantly increased,as compared with those before operation,postoperative CTX-Ⅰlevel was lower in PKP group than in PVP group,whereas IGF,T,and healthy feeling and body health score in the SF-36 were higher than that of PVP group(P<0.05).There was no statistically significant difference in the incidence of complications between the two groups(P>0.05).Conclusion PVP and PKP both have significant effects in the treatment of OVCFs,which can improve the pain of patients.However,PKP has a better effect on lumbar motor functio

关 键 词：脊柱骨折 骨质疏松性骨折 骨折 压缩性 椎体后凸成形术 椎体成形术 疼痛 手术后 Ⅰ型胶原C端异物肽 胰岛素样生长因子 生活质量 

分 类 号：R683.2[医药卫生—骨科学]