经皮椎体成形术治疗两种椎体压缩骨折的效果

The Clinical Effect of Percutaneous Vetebroplasty for Osteoporotic Vertebral Compression Fracture

目的探讨经皮椎体成形术治疗骨质疏松性胸腰椎椎体新鲜压缩骨折和陈旧性压缩骨折的疗效。方法应用经皮椎体成形术治疗骨质疏松性椎体压缩骨折患者62例,共80个椎体。其中新鲜骨折(A组)42例,56个椎体;陈旧性骨折(B组)20例,24个椎体。对两组患者单个椎体的手术时间、骨水泥渗漏、术后伤椎高度增加、Cobb角纠正度数及手术前后VAS评分进行比较。结果术后疼痛均明显缓解或消失。A组术前VAS评分(6.8±1.3)分,术后1 d(2.2±0.6)分;B组术前VAS评分(6.1±1.4)分,术后1 d(2.1±0.8)分。组间术后与术前比较差异有统计学意义(P<0.05),两组间比较差异无统计学意义(P>0.05)。A组术后伤椎高度增加值(2.5±1.7)mm,B组(0.8±0.4)mm;两组间比较差异有统计学意义(P<0.05)。A组Cobb角纠正度数(5.7±1.2)°,B组(1.4±1.3)°,两组间比较差异有统计学意义(P<0.05)。随访6～30个月,平均16.2个月,无患椎再骨折和邻近椎体骨折发生,伤椎高度A、B两组均无明显丢失,两组间比较差异无统计学意义。骨水泥渗漏:A组15例17个椎体;B组8例9个椎体,两组间比较差异无统计学意义(P>0.05)。结论经皮椎体成形术治疗骨质疏松性椎体压缩新鲜与陈旧性骨折安全有效,新鲜骨折的复位效果优于陈旧性骨折,短期疗效满意。

Objective To evaluate the therapeatic effects of the percutaneous vertebroplasty（PVP） in treating fresh and old osteoporotic vertebral compression fractures（OVCF）.Methods 80 vertebrae in 62 patients underwent unilateral PVP for OVCF.Group A：56 vertebrae in 42 patients with fresh fractures.Group B：24 vertebrae in 20 patients with old fractures.The fatcors considered included the operative time,the PMMA leakage,the improvement of local cobb angle,the VAS and the height of the injured vertebra of preoperative and postoperative.Results Pain velief and mobility improvement were observed after the operation.Preoperative and postoperative VAS were 6.8±1.3 and 2.2±0.6 in group A and 6.1±1.4 and 2.1±0.8 in group B respectively（P〉0.05）.The height of injured vertebra increased（2.5±1.7） mm in group A and（0.8±0.4） mm in group B（P〈0.05）.The postoperative kyphosis Cobb angle corrected（5.7±1.2）°for group A and corrected（1.4±1.3）°for group B（P〈0.05）.All patients were followed up for 16.2 months on average（from 6 to 30 months）.There no vertebra fractures and adjacent vertebra fractures,and the postoperative loss of height was not obvious in both group A and group B.Ther were PMMA leakage in 17 vertebrae in 15 patients in group A and 9 vertebrae in 8 patients in group B in both（P〉0.05）.Conclusion The PVP is safe and effective for fresh and old osteoporotic vertebral compression fractures.The reduction of the fractures for the fresh fractures was better than for old fractures.The short-term effects is satisfactory.