经皮椎体成形术与保守疗法治疗骨质疏松性椎体压缩骨折的疗效对比

Comparison study of percutaneous vertebroplasty with conservative therapy for osteoporotic vertebral compression fractures

目的探讨经皮椎体成形术(PVP)与保守疗法治疗骨质疏松性椎体压缩骨折(OVCF)的疗效。方法回顾性分析2006年6月至2011年6月郑州市骨科医院收治并有完整随访资料的78例OVCF患者的临床资料。其中PVP治疗(手术组)36例,保守治疗(保守组)42例。对两组患者治疗前,治疗后1周、1个月、3个月、1年的疼痛视觉模拟评分(VAS)以及治疗前,治疗后3个月、1年的椎体高度丢失率进行对比研究,同时比较两组患者在住院时间、住院费用方面的差异。结果全组患者获随访12～36个月,平均随访时间18个月。两组患者VAS在治疗后各时相点的差异有统计学意义(P<0.05)。两组治疗前、治疗后3个月椎体高度丢失率比较,差异无统计学意义(P>0.05);两组治疗后1年椎体高度丢失率比较,差异有统计学意义(P<0.05)。手术组治疗前后椎体高度丢失率比较,差异无统计学意义(P>0.05);而保守组治疗后1年椎体高度丢失率明显高于治疗前(P<0.05),即出现明显的椎体高度丢失。保守组住院时间长于手术组,住院费用低于手术组,差异有统计学意义(P<0.05)。结论与保守治疗相比,PVP治疗OVCF尽管费用较高,但具有快速减轻患者痛苦、有效减少住院时间、临床疗效显著的优势。

Objective To investigate the advantages and disadvantages of percutaneous vertebroplasty（PVP） and conservative therapy for osteoporotic vertebral compression fractures （OVCF）. Methods From June 2006 to June 2011, 78 OVCF patients who had complete lbllow-np materials were treated by PVP （36 patients, group 1） or conservative therapy group （42 patients, group 2） in Zhengzhou Orthopaedics Hospital. Difference of Visual Analogue Score （VAS） between two groups was compared at file different fimepoint （before the treatment, I week, 1 monfli, 3 months and I year after the treatment） respectively, difference of loss rate of vertebral height between group I and group 2 was also compared before the treatment, at 3 months and 1 year after the treatment. The average length of hospital stay and hospitalization expenses of two gloups were recorded and compared with each other. Results All patients were followed up from 12 to 36 months with the average of 18 months. The difference of VAS score between two groups had statistically significant at each timepoint （P ~ 0.05）, The loss rate of vertebral height between two groups had no difference befbre the breatment and at 3 months after the treatment （P ~〉 0.05）, while the difference had statistical significance at l year after the treatment （P 〈 0.05）. VAS score had statistical difference between pre-treatment and post-treatment in two groups （P 〈Z0.05）. There was no statistical dif^brence of the loss rate of vertebral height between pre-treatment and post-treatment in group I（P ~0.05）, while in group 2, there had statistical difference between pre-treatment and 1 year after the treatment （P ~ 0.05） which indicated obvious loss of vertebral height. The length of hospital stay of group I was shorter than that of group 2, and the hospitalization expenses ofgrot.p I were higher than those of group 2 （P 〈 0.05）. Conclusions Compared with conservative therapy, PVP has obvious advantages for the treatment of patients with OVCF, because PVP could alleviate the pain quickly, shorten hospital day and thus bring about effective clinical effect, although it needs high expenses.