数字减影血管造影导向下椎体成形术治疗老年人胸椎压缩性骨折近期疗效观察

Clinical effect of percutaneous vertebroplasty monitored by digital subtraction angiography in elderlypatients with thoracic vertebral compression fracture： a short-term study

目的探讨经皮椎体成型术（PVP）治疗老年骨质疏松性上、中段胸椎压缩骨折的可行性及疗效。方法本研究共纳入101患者，其中PVP治疗组（观察组）55例，保守治疗组（对照组）46例。通过治疗前后的视觉模拟疼痛评分（VAS）评分、Oswestry功能障碍指数（ODD评分、椎体高度及Cobb角的变化来评价两种治疗方式的临床疗效。结果手术后48h及6周后，观察组VAS评分、ODI评分明显低于对照组（P〈0．05）；治疗后6个月后，两组VAS评分、ODI评分差异无统计学意义（P〉O．05）。治疗6个月后，对照组椎体前、中柱平均高度有不同程度下降，Cobb角增大；观察组则无明显变化，两组比较差异有统计学意义（P〈0．05）。结论PVP治疗上、中段胸椎骨质疏松性骨折是一种安全有效的方法，近期、远期评价指标优于保守治疗。但PVP对于手术者专业技术水平及影像监视设备要求较高，并且存在一定的风险，建议在高清透视设备下进行，需谨慎对待。

Objective To discuss the feasibility and the effects of percutaneous vertebroplasty （PVP） in the treatment of the osteoporotic compression fracture in theupper and middle thoracic vertebrae. Methods The study included 101 patients. 55 cases were treated with PVP （observation group） and 46 cases were treated with conservative treatment （control group）. The clinical efficacy of those two different treatment methods was evaluated by the changes of VAS score, ODI score, vertebral height and Cobb angle before versus after treatment. Results VAS and ODI scores at 48 hours and 6 weeks after treatment was significantly lower in observation group than in the control group （all P〈0.05）. Although there was no significant difference in VAS and ODI scores between the two groups after 6 months of treatment （both P〈0.05）, the anterior and middle vertebral height was decreased and Cobb angle of spine was increased in control group as compared with observation group （both P〈 0. 05）. Conclusions PVP is an effective and safe method in the treatment of osteoporotic vertebral compression fractures in upper and middle thoracic vertebrae. The short and long-term evaluation indexes are better in PVP than in conservative treatment. But the surgery should be proceeded under highly clear perspective equipment by the surgeons with highly level professional technology. Because the surgery is highly risky, surgery should be proceeded with cautions.