骨质疏松性椎体骨折不同复位程度椎体成形比较  

Comparison of different reduction heights with a reductor ahead of percutaneous vertebroplasty for osteoporotic vertebral compression fractures

作　　者：马航展 贺少杰 谢一心[1] 朱耀林 李伟宽 古浩坤 孔畅[1] MA Hang-zhan;HE Shao-jie;XIE Yi-xin;ZHU Yao-lin;LI Wei-kuan;GU Hao-kun;KONG Chang(Departmentof Spine Surgery,Panyu Hospital of Traditional Chinese Medicine,Guangzhou 511400,China)

机构地区：[1]广东省广州市番禺区中医院脊柱外科,广东广州511400

出　　处：《中国矫形外科杂志》2023年第20期1854-1859,共6页Orthopedic Journal of China

基　　金：广东省中医药局科研项目(编号:20201278);番禺区科技计划项目(编号:2021-Z04-074)。

摘　　要：[目的]评价骨折复位器不同复位高度联合经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗骨质疏松性椎体压缩性骨折(osteoporotic vertebral compression fractures,OVCF)的疗效。[方法]2020年1月—2021年12月本院收治的86例单节段OVCF患者,随机分为3组。所有患者均行仰卧位复位器复位后PVP术,其中,低复位组30例,复位器高度7~9 cm;中复位组29例,高度10~12 cm;高复位组27例,高度为13~15 cm。比较三组患者的围手术期、随访和影像资料。[结果]低复位组骨水泥注入量显著少于中复位组和高复位组[(3.4±0.9)ml vs(4.1±0.9)ml vs(3.9±1.0)ml,P=0.015],三组间骨水泥渗漏率差异无统计学意义(P>0.05)。所有患者均获随访12个月以上,随时间推移,三组患者术后VAS和ODI评分均显著降低(P<0.05)。术前至术后6个月,三组间VAS评分的差异无统计学意义(P>0.05),所有相应时间点,三组间ODI评分差异无统计学意义(P>0.05)。但是,末次随访时低复位组的VAS评分显著大于中复位组和高复位组[(1.4±0.9)vs(0.9±0.7)vs(0.9±0.8),P=0.020]。影像方面,随访过程中新发或再发骨折为低复位组2例(6.7%),中复位组3例(10.3%),高复位组6例(22.2%),但差异无统计学意义(P>0.05)。与术前相比,术后三组患者椎体前缘高度和局部后凸角均显著改善(P<0.05)。术前三组间椎体前缘高度和局部后凸角的差异均无统计学意义(P>0.05),术后相应时间点低复位组的椎体前缘高度和局部后凸Cobb角均显著不及中复位组及高复位组(P<0.05);高复位组与中复位组间椎体前缘高度及局部Cobb角的差异均无统计学意义(P>0.05)。[结论]不同复位高度PVP治疗OVCF均能有效缓解疼痛,提高患者术后生活质量。采用10 cm以上的复位高度能够更好地恢复骨折椎体前缘高度及改善后凸畸形。[Objective]To compare the clinical outcomes of different reduction heights with a self-developed reductor before percuta-neous vertebroplasty(PVP)for osteoporotic vertebral compression fracture(OVCF).[Methods]A total of 86 patients with single-segment OVCF admitted to our hospital from January 2020 to December 2021 were randomly divided into 3 groups.All patients underwent PVP af-ter fracture reduction in supine position with the self-developed reductor.Of them,30 patients in the low reduction(LR)group received re-duction with the reductor height of 7~9 cm,29 patients in the middle reduction(MR)group were with the height of 10~12 cm,while the re-maining 27 patients in the high reduction(HR)group were with the height of 13~15 cm.The perioperative period,follow-up and imaging data of the three groups were compared.[Results]The LR group had significantly less amount of bone cement injected in PVP than the MR and HR groups[(3.4±0.9)ml vs(4.1±0.9)ml vs(3.9±1.0)ml,P=0.015],although there was no a significant difference in bone cement leak-age rate among the three groups(P>0.05).With time of follow-up lasted for more than 12 months,the VAS and ODI scores significantly de-creased in the three groups(P<0.05).Nevertheless,there were no significant differences in terms of VAS scores between the three groups preoperatively to 6 months postoperatively(P<0.05),and ODI scores at any time points accordingly(P<0.05),the LR group proved signifi-cantly higher VAS scores than the MR and HR groups at the latest follow-up[(1.4±0.9)vs(0.9±0.7)vs(0.9±0.8),P=0.020].Regarding to imaging,the new-onset or recurrent fractures during follow-up were found in 2 cases(6.7%)in the LR group,3 cases(10.3%)in the MR group,and 6 cases(22.2%)in the HR group,whereas which was not statistically significant(P>0.05).Compared with those preoperatively,the anterior vertebral height and local kyphotic Cobb angle significantly improved in all the three groups postoperatively(P<0.05).There were no significant differences in anterior vertebral height and

关 键 词：骨质疏松性椎体压缩性骨折 复位器 复位高度 经皮椎体成形术 

分 类 号：R683.2[医药卫生—骨科学]