联合复位椎体成形术与椎体后凸成形术治疗骨质疏松性椎体骨折效果分析  

Effect analysis of treating osteoporotic vertebral fracture combined reduction vertebroplasty with kyphoplasty

作　　者：刘家寅[1] 刘兰泽[1] 孙汝涛[1] 王旭[1] 黄玉国[1] 孙来卿[1] 郭晓辉[1] 田发明 Liu Jiayin;Liu Lanze;Sun Rutao;Wang Xu;Huang Yuguo;Sun Laiqing;Guo Xiaohui;Tian Faming(Department of Spine,The Second Hospital of Tangshan,Hebei Province,Tangshan 063000,China;School of Public Health,North China University of Science and Technology,Tangshan 063210,China)

机构地区：[1]河北省唐山市第二医院脊柱科,唐山063000 [2]华北理工大学公共卫生学院,唐山063210

出　　处：《中国综合临床》2022年第3期250-255,共6页Clinical Medicine of China

基　　金：河北省青年拔尖人才支持计划项目(JI-2016-10);河北省高校百名优秀创新人才支持计划(JJK-2019-14-SLRC2019029)。

摘　　要：目的比较体位复位联合穿刺针撬拨复位经皮椎体成形术(percutaneous vertebroplasty,PVP)与经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCFs)临床效果。方法选取2019年1月至2020年1月唐山市第二医院符合纳入和排除标准的68例OVCFs患者纳入观察研究。采用前瞻性随机对照研究方法。应用计算机随机数字法进行匹配分组,分为PVP联合组(调整手术床过伸20°~30°,如体位复位失败,依术前终板压缩程度双侧穿刺针反向撬拨,推注骨水泥)和PKP组(术前不调整手术床,穿刺后置入球囊并双侧扩张,推注骨水泥),每组各34例。术前拍摄患者腰椎正侧位X线片测量伤椎Cobb角,采用视觉模拟评分(visual analogue scale,VAS)和Oswetry功能障碍指数(Oswestry disability index,ODI)评估患者疼痛程度及腰背功能。术中记录手术时间、透视次数。术后第2天拍腰椎正侧位X线片测量伤椎Cobb角、行电子计算机断层扫描(computed tomography,CT)检查骨水泥是否渗漏、记录VAS评分,术后3个月记录ODI评估患者腰背功能。术后12个月末次随访,统计患者治疗费用及再骨折情况。呈正态分布的计量资料组间比较采用独立样本t检验,组内手术前后比较采用配对样本t检验;计数资料组间比较采用χ^(2)检验。结果患者均获得随访,时间12个月。PVP联合组手术时间[(42.7±5.9)min]、透视次数[(20.0±3.6)次]、治疗费用[(19153±601)元]均优于PKP组[(67.4±7.3)min、(30.1±5.9)次、(27496±669)元],两组比较差异均有统计学意义(t值分别为15.39、8.46、54.12,均P<0.001)。Cobb角:两组术后伤椎Cobb角[PVP联合组(10.7±4.5)°、PKP组(13.4±3.8)°]较术前[PVP联合组(17.0±5.1)°、PKP组(16.7±5.1)°]下降,差异均有统计学意义(t值分别为10.61、5.61,均P=0.001),且PVP联合组较PKP组恢复较好,两组比较差异有统计学意义(t=2.70,P=0.009)。PVP联Objective To compare postural reduction combined with percutaneous vertebroplasty(PVP)and percutaneous kyphoplasty(PKP)in the treatment of osteoporotic vertebral compression fractures(OVCFs).Methods From January 2019 to January 2020,68 patients with OVCFs who met the inclusion and exclusion criteria in the Second Hospital of Tangshan Hebei Province were included in the observation study.A prospective randomized controlled study was used.The matched groups were divided into PVP combined group(adjust the overextension of the operating table by 20°-30°,if the posture reduction fails,pry the puncture needle on both sides in reverse according to the compression degree of the end plate before operation,and inject bone cement)and PKP group(do not adjust the operating table before operation,insert a balloon and expand on both sides after operation,and inject bone cement),with 34 cases in each group.The Cobb angle of the injured vertebrae was measured by taking the anterior and lateral X-ray film of the patient's lumbar spine before operation.The degree of pain and low back function were evaluated by visual analogue scale(VAS)and Oswetry disability index(ODI).The operation time and fluoroscopy times were recorded during the operation.On the second day after operation,the anterior and lateral X-ray of lumbar spine were taken to measure the Cobb angle of injured vertebrae.All patients were underwent computed tomography(CT)check the bone cement for leakage,record the VAS score,and record the ODI 3 months after operation to evaluate the patient's function.Follow up at the end of 12 months after operation to count the treatment cost and re-fracture of the patient.The data analysis and measurement data were compared by independent sample t-test between the two groups,paired sample t-test was used for intra-group comparison before and after operation.χ^(2) test was used for counting data comparison between two groups.Results All patients were followed up for 12 months.The operation time((42.7±5.9)min),fluoroscopy times((20.0

关 键 词：骨质疏松性椎体压缩骨折 椎体成形术 体位复位 穿刺针撬拨复位 椎体后凸成形术 

分 类 号：R687.3[医药卫生—骨科学]