三种不同方法治疗骨质疏松性椎体压缩性骨折对骨密度的影响

The influence of three different methods for the treatment of osteoporotic vertebral compression fracture on bone density

目的探讨三种不同治疗方法对骨质疏松性椎体压缩性骨折患者骨密度的影响。方法53例骨质疏松性椎体压缩性骨折患者按治疗方法分为保守治疗组、椎体成形术（PVP）组和球囊扩张椎体后凸成形术（PKP）组，于治疗前、治疗后3个月、半年、1年、1年半用定量cT骨密度仪测量骨密度（L2-4 椎体），并进行比较。结果PVP组及PKP组治疗前后、随访期间骨密度改变不明显，治疗后3个月骨密度较治疗前稍下降，其中PVP组由（86．12±8．21）mg／cm3下降至（85．23±8．31）mg／cm3，PKP组由（86．32±8．38）mg／cm3下降至（84．98±8．26）mg／cm3，但差异均无统计学意义（P〉0．05），半年后骨密度恢复到受伤前水平。保守治疗组治疗后3个月及半年随访发现骨量丢失明显，骨密度下降显著[（74．42±8．36）、（76．10±8．31）mg／cm3比（86．87±8．27）mg／cm3]，差异有统计学意义（P〈0．05），治疗后1年，骨密度与治疗前比较差异无统计学意义（P〉0．05）。PVP组和PKP组治疗后3个月和半年骨密度显著高于保守治疗组[（85．23±8．31）、（84．98±8．26）mg／cm 比（74．42±8．36）mg／cm3和（86．23±8．05）、（86．41±8．17）mg／cm3比（76．10±8．31）mg／cm3]，差异有统计学意义（P〈0．05），治疗后1年及1年半，三组骨密度比较差异无统计学意义（P〉0．05）。结论PVP、PKP是治疗骨质疏松性椎体压缩性骨折的积极方法，能够减少骨量丢失，早期行功能锻炼，防止脆性骨折和椎体压缩性骨折进一步加重，是一种较好的临床治疗方法。

Objective To observe the effect of three different methods for the treatment of osteoporotic vertebral compressive fractures on bone density. Methods Fifty-three patients with osteoporotic vertebral compressive fractures were retrospectively analyzed. These patients were divided into conservative treatment group,vertebroplasty （PVP） group and balloon kyphoplasty （PKP） group. Quantitative computed tomography measurement of bone density （L2-4） was performed before treatment, after treatment for 3 months, half a year, 1 year, I and half a year. Results Before and after treatment, no significant changes was found in bone density during follow-up in PVP group and PKP group. Bone density was decreased after treatment for 3 months compared with that before treatment, from （86.12 ± 8.21 ） mg/cm3 to （85.23 ± 8.31 ） mg/cm3 in PVP group, from （86.32 ± 8.38） mg/cm3 to （84.98 ± 8.26） mg/cm3 in PKP group, but there was no significant difference （P 〉 0.05 ）, bone density returned to pre-injury level after treatment for half a year. Bone loss was found significantly after treatment for 3 months and half a year follow-up in conservative treatment group, bone density decreased significantly[ （74.42 ± 8.36）, （76.10 ± 8.31 ） mg/em3 vs. （86.87 ± 8.27） mg/cm3],and there was significant difference （P 〈0.05）,and there was no significant differencebetween after treatment for 1 year and before treatment （P 〉 0.05 ）. Bone density after treatment for 3 months and halfa year in PVP group and PKP group was higher than that in conservative treatment group [ （85.23 ± 8.31 ）, （84.98 ± 8.26） mg/cm3 vs. （74.42 ± 8.36） mg/cm3 and （86.23 ±8.05）, （86.41 ± 8.17） mg/cm3 vs. （76.10 ± 8.31 ） mg/cm3] ,and there was significant difference （P 〈 0.05 ）. There was no significant difference among three groups after treatment for 1 year and 1 and half a year（P 〉 0.05）. Conclusions PVP and PKP are positive treatment of osteoporotic vertebral compression fractures, which could reduce the loss of bone mass and do function exercise early. It could prevent brittle fracture and vertebral compression fracture further aggravated, which are a better clinical treatment methods.