经皮椎体成形术治疗骨质疏松椎体压缩骨折的综合疗效评价

Clinical Efficacy of Vertebroplasty for Treatment of Painful Osteoporotic Vertebral Compression Fractures:A Prospective Analysis

目的 前瞻性评估经皮椎体成形术(PVP)治疗骨质疏松性椎体压缩骨折患者的生活质量及无症状骨水泥渗漏是否影响远期疗效。资料与方法用视觉模拟评分法(VAS)、生活自理能力表(ADL)和下腰部活动障碍表(OLBPDQ)前瞻性评价疼痛性椎体压缩骨折126例PVP治疗术前及术后不同时期的综合疗效。结果 平均随访9.9个月(3～24个月),获得完整随访资料有72例。术前、术后1天、1个月、3个月、6个月及1年以上随访时VAS分别为8.53±0.85、3.22±1.20、3.06±1.02、2.06±0.98、1.61±0.85及1.24±0.85,术后1天VAS平均下降了5.31;Barthel指数术前、术后1周、1个月、3个月、6个月及1年以上分别为40.5±16.9、69.4±22.3、78.5±20.6、87.3±15.1、91.7±9.7、93.0±7.9,术后1周较术前提高了28.9(71%);ODI指数术前、术后1周、1个月、3个月、6个月及1年以上分别为33.81±5.54、20.90±5.31、16.90±4.78、12.11±6.41、9.71±4.82、8.69±4.81,术后1周较术前下降了12.91(38%)。术后CT证实骨水泥在椎旁少量渗漏共有12例18节,其各随访时点VAS、ADL及ODI总分分别与无渗漏的60例同期比较均无显著性差异(P>0.5)。结论 PVP治疗疼痛性骨质疏松椎体压缩骨折可迅速缓解患者疼痛和提高生活质量,而且疗效可保持长期稳定;无症状骨水泥渗漏对患者生命质量无影响。

Objective To prospectively evaluate the quality of life in patients with painful osteoporotic vertebral compression fractures（OVCF）following percutaneous vertebroplasty（PVP）and to evaluate the long term efficacy of those patient with asymptomatic cement leakages around vertebrae.Materials and Methods PVP was performed in 126 patients with osteoporotic painful vertebral compression fractures.The efficacy of the PVP was assessed by the VAS,ADL and ODI before and after PVP.Results The mean follow-up was 9.9 months（3～24 months）.72 consecutive patients were successfully followed up for more than 3 months.The average VAS significantly decreased from a mean preoperative score of 8.53±0.85 to a mean postoperative score of 3.22±1.20（post-24 hours）,3.06±1.02（post-1 months）,2.06±0.98（post-3 months）,1.61±0.85（post-6 months）and 1.24±0.85 at the last follow-up.The mean Barthel Index significantly improved from 40.5±16.9 before PVP to 69.4±22.3 at a week,78.5±20.6 at a month,87.3±15.1 at 3 months,91.7±9.7 at 6 months and 93.0±7.9 at more than 1 year after PVP procedure.The ODI significantly decreased from 33.81±5.54 before PVP to 20.90±5.31 at a week,16.90±4.78 at a month,12.11±6.41 at 3 months,9.71±4.82 at 6 months and 8.69±4.81 at more than a year after PVP.No serious complications related to the technique occurred,except 12 cases with asymptomatic cement leakage around 18 vertebrae demonstrated by CT during follow-up period.There was not significantly difference in VAS,ADL and ODI between 12 cases with cement leakage around vertebrae and 60 cases with no cement leakage.Conclusion Percutaneous vertebroplasty,which provides immediate and durable pain relief and maintains persistent improvement in quality of life,is an effective and safe procedure for treating vertebral compression fractures in patients with osteoporosis.Asymptomatic cement leakages around vertebrae have no influence on quality of life in these patients.