经皮椎体成形术及后凸成形术治疗骨质疏松性椎体压缩骨折的临床对比研究

Comparison of percutaneous vertebroplasty and kyphoplasty in the treatment of osteoporotic vertebral compression fractures

目的探讨和比较经皮椎体成形术（pereutaneous vertebroplasty，PVP）和后凸成形术（percutaneous kyphoplasty，PKP）治疗骨质疏松性椎体压缩骨折（osteoporotic vertebral compression fractures，OVCFs）的疗效、安全性和效价比。方法回顾性分析72例（共96椎）经PVP（34例）和PKP（38例）治疗的OVCFs患者的临床病历资料，并进行比较。72例患者均在C形臂机透视导向下经皮穿刺椎弓根到病变椎体，然后，PVP组在病变处直接注入骨水泥；PKP组在病变部位置入球囊进行扩张后注入骨水泥。记录手术透视时间、每椎骨水泥注射量和治疗费用（手术费＋耗材费）。统计手术前和手术后24h、1周、1个月疼痛视觉模拟评分（visual analogue scale，VAS），以及手术前后椎体前缘和中部高度、Cobb角矫正情况，观察术后症状改善、并发症发生情况。结果中计量资料2组间的比较采用t检验，多组资料的比较采用方差分析；计数资料采用x^2检验。结果所有患者的治疗操作均顺利并成功，术后随访1．0～34．0个月，平均（8．9±3．2）个月。（1）PVP组平均手术透视时间为（11．1±10．6）min／椎，PKP为（23．5±13．0）min／椎，两者差异有统计学意义（P〈0．05）。（2）PVP组平均治疗费用为（5127．2±502．3）元／例，PKP为（32301．4±3204．6）形例，两者差异有统计学意义（P〈0．05）。（3）PVP组平均每椎骨水泥注射量为（4．9±1．1）ml，PKP为（5．4±1．7）ml，两者差异无统计学意义（P〉0．05）。（4）术后24h疼痛缓解率PVP组为94．1％（32／34）、PKP组为92．1％（35／38），两者差异无统计学意义（P〉0．05）。PKP组VAS评分术前，术后24h、1周、1个月分别为（8．3±0．4）、（2．9±0．9）、（2．6±0．9）、（2．6±0．9）分，术前和术后各时间点比较差异均有统计学意义（P值均〈0．05）；PVP组VAS评分术前，术后24h、1周、1个月分别为（7．9±0．8）、（2．8±1．2）、（2．6±1．1）、（2．5±1．3）分，术前和术后各时问点比较差异均有统计学意义（P值均〈0．05）；而PVP和PKP两种手术方法间比较差异无统计学意义（P〉0．05）。（5）PVP组术前椎体前缘、中部高度及Cobb角分别为（19．14-1．4）mm、（25．2±1．0）mm、（24．2±3．8）°，术后分别为（21．0±1．5）mm、（27．0±1．2）mm、（19．4±3．9）°，术前和术后比较差异均有统计学意义（P值均〈0．05）；PKP组术前椎体前缘、中部高度及Cobb角分别为（19．5±1．5）mm、（25．4±1．1）mm、（25．1±5．0）°，术后分别为（24．3±1．9）mm、（29．7±1．3）mm、（10．7±2．8）°，术后和术前比较差异均有统计学意义（P值均〈0．05）；PKP组矫正效果优于PVP组，两者差异有统计学意义（P值均〈0．05）。（6）PVP组9例椎骨发生水泥渗漏，PKP组3例椎骨发生水泥渗漏，两者差异有统计学意义（P〈0．05）。所有骨水泥渗漏均未引起临床症状。（7）所有经治患者未发现其他严重并发症。结论PVP和PKP治疗OVCFs效果良好、安全，但PVP效价比优于PKP。

Objective To investigate and compare the efficacy, safety, and cost effectiveness in the treatment of painful osteoporotic vertebral compression fractures （ OVCFs ） with percutaneous vertebroplasty （PYP） and kyphoplasty（PKP）. Methods Seventy-two patients （96 vertebrae） with painful OVCFs were treated by PVP （n = 34） or PKP （n = 38） under radiological monitoring. After bone biopsy needle into the compressed vertebra, bone cement （polymethylmethacrylate） was injected in PVP group, and that was inserted followed by the inflation of vertebra to create cavities in PKP group. The fluoroscopy time, total amount of bone cement injected, and cost were recollected respectively. The score of visual analogue scale point（VAS, 10-point scale）was determined at before the procedures, and 24 hours, one week, and one month after the procedures. Pain relief and complications were observed. The Cobb angle and vertebral heights of the anterior, middle, and posterior border were measured pre-and post-operative. Results The two procedures were technically successful in all patients. The follow-up ranged from 1.0 to 34. 0 months [ mean time, （8.9 ± 3.2） months ]. The Mean fluoroscopy time of treating per vertebra in PVP group was （ 11.1 ± 10. 6） rain, which was significant shorter than that （23.5 ± 13.0） min in PKP group（P 〈0. 05）. The mean total cost per patient was （5127.2 ± 502. 3 ） yuan in PVP group, which were strikingly lower than that（ 32 301.4 ± 3204. 6 ） yuan in PKP group （ P 〈 0. 05 ）. （ 3 ） There was no significant difference （ P 〉 0. 05）in average cement volumes in PVP group[ （4. 9 ± 1.1 ） ml] and PKP group[ （5.4 ± 1.7） ml]. Pain relief of was observed in 94. 1% （32/34） of PVP group and in 92. 1% （35/38） of PKP group. The score of VAS at pre-operation was （8.3 ± 0. 4 vs 7.9± 0. 8）, and at post-operative 24 h （2. 9 ± 0. 9 vs 2. 8 ± 1.2）, 1 week （2. 6 ± 0. 9 vs 2. 6 ± 1.1 ）, and 1 month （2. 6± 0. 9 vs 2. 5 ± 1.3 ） were no difference at PKP and PYP group（P 〈 0. 05）. There was significant difference between pre- and post-operative time point in each group. The Cobb angle, anterior and middle height of vertebra was corrected in both PVP and PKP group. In PVP group, the preoperative Cobb angle, anterior and middle height of vertebra was （ 24.2 ± 3.8 ） ° , （ 19. 1 ± 1.4） mm, （25.2 ± 1.0） mm, which was significant different （P 〈 0. 05 ） from that of （ 19.4 ±3.9）°, （21.0 ±1.5） mm, （27.0 ±1.2） mm at pre-operation. In PKP group,there was significant difference （P 〈 0. 05 ） in the preoperative Cobb angle, anterior and middle height of vertebra [ （25. 1 ± 5.0）°vs（10.7±2.8）°, （19.5±1.5） mm vs （24.3±1.9） mm, （25.4±1.1） mm vs （29.7± 1.3） ram, respeetively）. As to the above index, the overall correcting effect in PKP was much better than that in PVP（P 〈0. 05）. Cement leakage occurred in 9 eases in PVP group and 3 eases in PKP group （P 〈 0. 05 ） but no symptoms. There were no major complications during operation in the two groups. Conclusion PVP and PKP are effective and safe in the treatment of painful OVCFs but PVP is more cost effective than PKP.