椎体骨折2周与4周内行椎体后凸成形术后疗效的比较研究

A comparison of vertebral height and bone cement leakage between surgical treatment within 2 weeks and 2 to 4 weeks by kyphoplasty for osteoporotic vertebral compression

目的比较骨质疏松性椎体压缩骨折后2周内（接受手术时病程≤14d）与2—4）周（14d〈接受手术时病程≤28d）行椎体后凸成形术后椎体高度及骨水泥渗漏的情况。方法回顾性分析2010年1月至2011年1月，采用椎体后凸成形术治疗48例骨质疏松性椎体压缩骨折患者资料，根据患者受伤至手术时间分为2周内和2—4周手术组，2周内手术组22例，男4例，女18例；年龄54—85岁，平均71．17岁。2～4周手术组26例，男5例，女21例；年龄56—88岁，平均73．12岁。两组患者骨折椎体均位于T2～L4。比较两组患者年龄、性别、骨密度T值、术前椎体高度丢失率、术中注入骨水泥量、术后椎体高度恢复率、术后1年椎体高度丢失率、骨水泥渗漏率。结果2周内和2—4N手术组术前椎体压缩程度、骨水泥注入量、骨密度T值、椎体高度恢复率分别为47％±21％和48％±19％、（3．69＋_1．03）ml和（3．66＋0．71）Tnl、-2．79＋_0．57和-2．87＋0．95、25％±8．3％和23％±7．7％，两组上述四项指标比较，差异均无统计学意义。2周内手术组1年椎体高度丢失率为9％±2．8％，2—4周手术组为11％＋2．9％，两组比较差异有统计学意义。2周内和2～4周手术组骨水泥渗漏率分别为22．2％（6／27）和11．8％（4／34），两组比较差异无统计学意义。结论骨质疏松性椎体压缩骨折后，2周内与2～4周行椎体后凸成形术均能较好恢复椎体高度，且骨水泥渗漏率相似，但2周内手术的患者术后1年椎体高度丢失率较小。

Objective To compare the vertebral height and bone cement leakage of osteoporotic vertebral compression fracture treated within 2 weeks （time from injury to surgery was less than 14 days） and in 2 to 4 weeks （time from injury to surgery was between 14 and 28 days） by kyphoplasty. Methods Retrospectively analyzed the data of 48 patients with osteoporotic verte- bral compression fracture treated by kyphoplasty from January 2010 to January 2011. According to the time from injury to surgery, patients were divided into two groups （surgery within 2 weeks and surgery between 2 and 4 weeks）. Twenty-two patients were in surgery within 2 weeks group： 4 males and 18 females; aged from 54 to 85 years, with an average age of 71.17 years; fractured seg- ments were distributed between T7 and L4. Twenty-six patients were in surgery between 2 and 4 weeks group： 5 males and 21 fe- males; aged from 56 to 88 years, with an average age of 73.12 years; fractured segments were distributed between T7 and L. Pa- tients＇ gender, age, bone mineral density, preoperative vertebral body compression rate, intraoperative iniection of bone cement volume, postoperative vertebral height restoration rate, 1-year follow-up postoperative vertebral height recollapse rate, and bone ce- ment leakage rate were recorded and compared, respectively. Results Preoperative vertebral body compression rate, intraopera- tive injection of bone cement volume, T-score of BMD, and postoperative vertebral height restoration rate were 47%_＋21% and 48%_＋ 19%, （3.69_＋ 1.03 ） ml and （3.66＋0.71 ） ml, -2.79_＋0.57 and -2.87_＋0.95,25%＋8.3% and 23%_＋7.7% in the surgery within 2 weeks group and surgery between 2 and 4 weeks group respectively. There was no significant difference in 4 indicators mentioned above between two groups. The 1-year follow-up postoperative vertebral height recollapse rates were 9%＋2.8% （surgery within 2 weeks） and 11%_＋2.9% （surgery between 2 and 4 weeks）, respectively. There was significant difference between two groups. Bone cement leakage rates were 22.2% （6/27） in surgery within 2 weeks group and 11.8% （4/34）in surgery between 2 and 4 weeks group. There was no significant difference between two groups. Conclusion Surgery within 2 weeks and surgery between 2 and 4 weeks can significantly achieve vertebral height restoration, and bone cement leakage rates were similar between two groups, while 1-year follow-up postoperative vertebral height recollapse rate was higher than that in the surgery between 2 and 4 weeks group.