PVP与PKP治疗伴真空征的无神经症状骨质疏松性椎体压缩骨折效果比较  

Efficacy of percutaneous vertebroplasty versus percutaneous kyphoplasty in treatment of osteoporotic vertebral compression fractures without neurological symptoms accompanied by intravertebral vacuum cleft

作　　者：王杰[1] 曹振鲁 孙元亮[1] 强炜 王娟[1] 王亭[1] WANG Jie;CAO Zhenlu;SUN Yuanliang;QIANG Wei;WANG Juan;WANG Ting(Department of Spinal Surgery,The Affiliated Hospital of Qingdao University,Qingdao 266000,China)

机构地区：[1]青岛大学附属医院脊柱外科,山东青岛266000

出　　处：《青岛大学学报（医学版）》2024年第4期541-547,共7页Journal of Qingdao University(Medical Sciences)

基　　金：山东省自然科学基金项目(2016ZRB01560)。

摘　　要：目的比较经皮椎体成形术(PVP)与经皮椎体后凸成形术(PKP)治疗伴有椎体内真空裂隙征(IVC)的无神经症状的骨质疏松性椎体压缩骨折(OVCFs)的效果。方法选取我院经椎体强化术治疗的伴IVC的无神经症状OVCFs病人62例(65个伤椎),随机分为两组,分别采用PVP及PKP治疗。比较两组病人术前、术后1d和末次随访时的视觉模拟评分法(VAS)评分、伤椎前壁高度占比和局部后凸Cobb角的变化。结果两组病人术后1d的VAS评分、伤椎前壁高度占比和局部后凸Cobb角均较术前有明显改善(P<0.01);与术后1d相比较,末次随访时两组病人VAS评分下降(P<0.05),PVP组伤椎前壁高度有丢失(P<0.05),PKP组后凸Cobb角有增加(P<0.01)。与PVP组比较,PKP组术后1d和末次随访时的伤椎前壁高度占比均更高,差异有统计学意义(F=6.243、7.664,P<0.05)。PVP组骨水泥渗漏和邻近节段骨折的发生率均低于PKP组,但差异无显著性(P>0.05)。结论PVP和PKP是治疗伴IVC的无神经症状OVCFs的有效方法。在恢复伤椎前壁高度方面PKP优于PVP,但PKP后局部后凸远期可能有加重。Objective To investigate the clinical efficacy of percutaneous vertebroplasty(PVP)versus percutaneous kyphoplasty(PKP)in the treatment of osteoporotic vertebral compression fractures(OVCFs)without neurological symptoms accompanied by intravertebral vacuum cleft(IVC).Methods A total of 62 OVCFs patients(65 fractured vertebrae)without neurolo-gical symptoms accompanied by IVC who underwent vertebral augmentation in our hospital were enrolled and randomly divided into two groups,and the two groups were treated with PVP and PKP,respectively.The two groups were compared in terms of Visual Analog Scale(VAS)score,anterior vertebral height ratio,and local kyphosis Cobb angle before surgery,on day 1 after surgery,and at the final follow-up.Results On day 1 after surgery,both groups had significant improvements in VAS score,the anterior vertebral height ratio of the fractured vertebra,and local kyphosis Cobb angle(P<0.01);then,at the final follow-up,both groups had a significant reduction in VAS score(P<0.05),and the PVP group had a significant reduction in the anterior vertebral height ratio of the fractured vertebra(P<0.05),while the PKP group had a significant increase in kyphosis Cobb angle(P<0.01).Compared with the PVP group,the PKP group had a significantly higher anterior vertebral height ratio of the fractured vertebra on day 1 after surgery and at the final follow-up(F=6.243,7.664,P<0.05).Compared with the PKP group,the PVP group had significantly lower incidence rates of bone cement leakage and adjacent segmental fractures(P>0.05).Conclusion Both PVP and PKP are effective methods for the treatment of OVCFs without neurological symptoms accompanied by IVC.PKP is superior to PVP in restoring the anterior vertebral height of the fractured vertebra,while there may be aggravation of local kyphosis in the long term after PKP.

关 键 词：椎体成形术 椎体后凸成形术 椎体 骨质疏松性骨折 骨折 压缩性 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]