经皮椎体成形及后凸成形术对临近椎间盘退变影响的回顾性分析研究

Study of effects of PVP and PKP on the adjacent intervertebral disc degeneration

[目的]探讨经皮椎体成形术(percutaneous vertebroplasty,PVP)和后凸成形术(percutaneous kyphoplasty,PKP)对临近椎间盘退变的可能影响及其程度。[方法]收集2009年6月～2011年2月济宁医学院附属医院脊柱外科收治的胸腰椎骨质疏松压缩骨折患者共146例,其中纳入本研究的具有完整随访资料患者85例,又按治疗方案的不同,分为保守治疗组20例、PVP组42例、PKP组23例,采集入院时、入院后3 d、出院后12个月、出院后24个月的VAS评分(visual analogue scale/score,视觉模拟评分法)、ODI评分(the Oswestry disability index,Oswestry功能障碍指数)和入院时、出院后12个月、出院后24个月的椎间盘指数和MRI指数,将所有数据资料进行归纳、汇总,应用SPSS 17.0统计软件行数据分析。[结果]PVP组和PKP组均能早期、有效地缓解疼痛、减少卧床时间、治疗满意度高,但出院后24个月的VAS评分和ODI评分分析,PVP组和PKP组无统计学差异(P>0.05)。在出院后24个月的椎间盘指数及MRI指数的比较中发现,PVP组和PKP组较保守治疗组均具有统计学差异(P<0.05),PVP组和PKP组较术前均具有统计学差异(P<0.05),且PKP组较PVP组具有统计学差异(P<0.05)。[结论]PVP和PKP均可加速相邻椎间盘退变,且后者影响更为显著。

[ Objective ] To investigate the effects of percutaneous vertebroplasty （PVP） and percutaneous kyphoplasty （PKP） on the adjacent intervertebral disc degeneration. [ Methods] From 2009 June to 2011 February, a total of 146 patients with osteoporotic vertebral compression fracture （OVCF） were treated in the Spinal Surgery of The Affiliated Hospital of Jining Medical College. The study included 85 patients with complete follow - up data. According to the different treatments, all pa- tients were divided into three groups, including the conservative treatment group 20, PVP group 42 and PKP group 23. VAS score, ODI score, DHI and MRII were collected respectively at different time points. SPSS17. 0 statistical software was used for data analysis. [ Results ] Compared with the conservative treatment group, PVP group and PKP group relieved pain effectively, reduced the time in bed, and had a better treatment satisfaction, but from the analysis of scores of VAS and ODI, there were no significant difference between the group PVP and the group PKP （P 〉 0.05 ） . In visit of the twenty - fourth months after dis- charge, from the analysis of DHI and MRII, there were significant difference between PVP group and conservative treatment group （ P 〈 0. 05 ）, and significant difference between the PKP group and the conservative treatment group （ P 〈 0. 05 ） . [ Conclusion] The disc degeneration adjacent to the fractured vertebral can be accelerated by PVP and PKP procedures, and the latter is more serious.