不同手术时机行经皮椎体球囊扩张后凸成形术治疗效果对比分析

Comparison analysis of percutaneous kyphoplasty at different operation times

目的探讨经皮椎体球囊扩张后凸成形术（PKP）治疗椎体骨质疏松型压缩性骨折（OVCFs）的临床最佳手术时机及其并发症的预防方法。方法2010年1月1日～2012年5月30日，我院（广州军区武汉总医院）行PKP治疗OVCFs患者73例，其中于受伤后1周内行手术治疗者28例（32个椎体）为早期手术组，伤后延期4周以上行手术治疗者45例（57个椎体）为延期手术组。比较两组Cobb角和椎体前缘高度术前、出院时和术后12个月随访结果，采用疼痛模拟视觉评分（VAS）评定疗效。结果早期手术组：平均每个椎体注射骨水泥量（5．2±1．3）ml，出院时VAS评分改善率为（78．5±12．1）％，Cobb角改善率为（51．1±9．2）％，伤椎前缘高度改善率为（72．6±6．4）％。延期手术组：平均每个椎体注射骨水泥量（3．6±0．9）ml，出院时VAS评分改善率为（54．5±10．6）％，Cobb角改善率为（46．1±9．2）％。伤椎前缘高度改善率为（49．5±5．1）％。两组术后12个月VAS评分分别为（1．4±0．5）分和（1．6±0．4）分，两组之间无明显差异。早期手术组有2例发生伤椎再骨折。早期手术组VAS评分改善率、Cobb角改善率和椎体前缘高度改善率均高于延期手术组（P〈0．05），延期手术组骨水泥渗漏率较早期手术组低。结论PKP是治疗OVCFs的有效方法，伤后早期手术治疗较延期手术治疗可迅速、明显减轻患者疼痛，更好地恢复椎体形态。控制骨水泥注射时的黏滞度和边注射边透视可减少骨水泥渗漏。

Objective To investigate the optimal operation time of percutaneous kyphoplasty （PKP） for os- teoporotic vertebral compression fractures （OVCFs） and the prevention of its complications. Methods From Jan. 2010 to May 2012, PKP operation was performed for 73 OVCFs patients. Twenty-eight cases （ 32 vertebral bodies ） who took surgical treatment at 1 week after injury were regarded as the early operation group （group A） ,and forty-five cases （57 vertebral bodies） who took operation more than 4 weeks after injury were taken as the delayed operation group （group B）. The Cobb angle and anterior vertebral height of all patients preoperatively,postoperatively and at 12 months after follow-up were compared between the two groups. The visual analogue scale （VAS） was used for the pain assessment. Results Group A ： the average amount of bone cement injected into each vertebral body was （5. 2 ±1.3） ml ,the improvement rate of VAS score was （78. 5±12. 1） % ,the improvement rate of Cobb Angle was （51.1 ±9. 2 ） % , the improvement rate of anterior height of the injured vertebra was （ 72. 6 ± 6. 4 ） %. Group B ： the average amount of bone cement injected into each vertebral body was （3. 6±0. 9 ） ml ,the improvement rate of VAS score was （54. 5 ＋ 10. 6） % ,the improvement rate of Cobb was （46. 1 ±9. 2） % ;the improvement rate of anterior height of the injured vertebral body was （ 49. 5 ± 5. 1 ） %. The VAS scores at 12 months after operation in the two groups were （ 1.4 ±0. 5 ） and （ 1.6 ±0. 4） ,respectively,without significant differences between the two groups. In group A,verte- bral refracture occurred in 2 cases. The improvements of VAS score, Cobb Angle and anterior height of the injured vertebral body were better than those in group B （ P 〈 O. 05 ）, while the bone cement leakage rate was lower than that in group B. Conclusion PKP is an effective method for OVCFs. Early surgical treatment can reduce patients＇ pain rapidly and significantly ,and it can better restore the vertebral shape than delayed surgical treatment. Controlling the viscosity of bone cement and taking fluoroscopic images while injecting can reduce leakage of bone cement.