不同入路PVP治疗老年骨质疏松椎体压缩性骨折的临床疗效对比研究  

Comparative study on the clinical efficacy of percutaneous vertebroplastyvia different approaches in the treatment of osteoporotic vertebral compression fractures in the elderly

作　　者：王必胜 马海军 刘学森 WANG Bi-sheng;MA Hai-jun;LIU Xue-sen(Department of Spinal Surgery,Henan Provincial Third People's Hospital,Zhengzhou 450006,Henan,CHINA)

机构地区：[1]河南省直第三人民医院脊柱外科,河南郑州450006

出　　处：《海南医学》2024年第5期669-675,共7页Hainan Medical Journal

基　　金：河南省科技攻关计划项目(编号:222102311650)。

摘　　要：目的 比较症状较重侧与较轻侧入路经皮椎体成形术(PVP)治疗老年骨质疏松椎体压缩性骨折(OVCF)的临床效果。方法 前瞻性选取2021年1月至2022年10月于河南省直第三人民医院择期行PVP治疗的91例老年OVCF患者纳入研究,根据随机数表法分为轻侧组(n=45)和重侧组(n=46)。轻侧组患者经症状较轻侧入路实施PVP,重侧组患者经症状较重侧入路实施PVP。比较两组患者的手术情况,比较术前、术后3个月、6个月的血清炎症-应激因子[C反应蛋白(CRP)、肿瘤坏死因子-α (TNF-α)、前列腺素E2 (PGE2)、皮质醇(Cor)]、瘦素(LP)、脂联素(APN)水平、腰椎稳定性指标、疼痛程度评分、腰椎功能评分;同时比较两组患者的并发症发生情况。结果 重侧组患者的住院时间、骨折愈合时间分别为(19.14±2.26) d、(2.81±0.33)个月,明显短于轻侧组的(20.45±2.51) d、(3.02±0.35)个月,差异均有统计学意义(P<0.05);经重复测量方差分析结果显示,血清CRP、TNF-α、PGE2、Cor水平组间-时间交互作用比差异均有统计学意义(P<0.05);组间比较,重侧组患者术后3个月、6个月,血清CRP、TNF-α、PGE2、Cor水平明显低于轻侧组,差异有统计学意义(P<0.05);组内比较,两组患者术前、术后3个月、6个月血清CRP、TNF-α、PGE2、Cor水平逐渐降低,差异均有统计学意义(P<0.05)。重侧组患者的LP明显低于轻侧组,APN明显高于轻侧组,差异均有统计学意义(P<0.05);术后3个月、6个月两组患者的伤椎前缘高度、后凸Cobb角比较差异均无统计学意义(P>0.05);术后3个月、6个月,两组患者的VAS评分分别为(2.17±0.71)分、(1.54±0.42)分,明显低于轻侧组的(2.96±0.80)分、(1.81±0.45)分,ODI评分分别为(24.18±3.27)分、(21.67±2.70)分,明显低于轻侧组的(26.95±3.34)分、(23.15±2.81)分,RDQ评分分别为(3.12±0.86)分、(2.19±0.65)分,明显低于轻侧组的(4.27±0.94)分、(3.04±0.81)分,差异均有统计学意义(P<0.05);重Objective To compare the clinical effects of percutaneous vertebroplasty(PVP) via the severe and mild sides in the treatment of osteoporotic vertebral compression fractures(OVCF) in elderly patients.Methods A prospective study was conducted on 91 elderly patients with OVCF who were scheduled for PVP treatment at the Henan Provincial Third People's Hospital from January 2021 to October 2022.The patients were randomly divided into a mild side group(n=45) and a severe side group(n=46) according to a random number table method,to receive PVP via the side with mild symptoms and the side with severe symptoms.The two groups were comparedin surgery,serum inflammatory-stress factors [C-reactive protein(CRP),tumor necrosis factor-alpha(TNF-α),prostaglandin E2(PGE2),cortisol(Cor)],leptin(LP),adiponectin(APN) levels,lumbar spine stability indexes,pain scores,and lumbar spine function scores in the pre-operative period,3 months and 6 months after surgery.Meanwhile,the complications were also compared between the two groups.Results The length of hospital stay and fracture healing time of patients in the severe side group were(19.14±2.26) days and(2.81±0.33) months,respectively,which were significantly shorter than(20.45±2.51) days and(3.02±0.35) months in the mild side group(P<0.05).The repeated measurement analysis of variance showed that serum CRP and TNF-α,PGE2,and Cor levels had statistically significant differences in inter-group comparison-time interaction(P<0.05).In inter-group comparison,serum CRP,TNF-α,PGE2,Cor of patients in the severe side group at 3 and 6 months after surgery were significantly lower than those in the mild side group(P<0.05).In intra-group comparison,serum CRP,TNF-α,PGE2,Cor of two groups before surgery,3 months and 6 months after surgery gradually decreased(P<0.05).LP in the severe side group was significantly lower than that of the mild side group,and the APN was significantly higher than that of the mild side group,with statistically significant differences(P<0.05).There was no statistic

关 键 词：骨质疏松椎体压缩性骨折 经皮椎体成形术 症状较重侧 症状较轻侧 炎症-应激因子 腰椎稳定性 腰椎功能 疼痛程度 

分 类 号：R683[医药卫生—骨科学]