过伸牵引弹性按压法联合经皮椎体成形术治疗骨质疏松性胸腰椎压缩骨折的临床研究

Clinical study on hyperextension traction elastic pressure combined with percutaneous vertebroplasty in the treatment of osteoporotic thoracolumbar vertebral compression fractures

目的:观察过伸牵引弹性按压法联合经皮椎体成形术治疗骨质疏松性胸腰椎压缩骨折的临床疗效和安全性。方法:将符合要求的90例骨质疏松性胸腰椎压缩骨折患者随机分为2组,每组45例。所有患者入院后均卧硬板床,后背垫软枕。治疗组采用过伸牵引弹性按压法联合经皮椎体成形术治疗,对照组单纯采用经皮椎体成形术治疗。比较2组患者治疗前、治疗后24 h及治疗后6个月的伤椎前缘高度、脊柱后凸Cobb’s角、腰背部疼痛视觉模拟评分、Oswsetry功能障碍指数评分及并发症发生情况。结果:①伤椎前缘高度。治疗前后不同时间伤椎前缘高度的差异有统计学意义,即存在时间效应[治疗组:(15.14±2.61)mm,(26.79±2.25)mm,(26.68±2.53)mm;对照组:(15.98±2.47)mm,(19.85±2.73)mm,(19.68±2.59)mm;F=22.532,P=0.031];2组患者伤椎前缘高度的组间差异总体上有统计学意义,即存在分组效应(F=5.421,P=0.000);除治疗前外(t=2.138,P=0.261),其余各时点对照组的伤椎前缘高度均小于治疗组(t=4.063,P=0.000;t=6.124,P=0.000);时间因素和分组因素之间存在交互效应(F=35.835,P=0.000)。②脊柱后凸Cobb’s角。治疗前后不同时间脊柱后凸Cobb’s角的差异有统计学意义,即存在时间效应[治疗组:(27.86°±1.81°),(8.24°±1.37°),(8.31°±1.63°);对照组:(27.43°±1.57°),(14.62°±1.55°),(14.75°±1.48°);F=22.462,P=0.021];2组患者脊柱后凸Cobb’s角的组间差异总体上有统计学意义,即存在分组效应(F=4.736,P=0.000);除治疗前外(t=1.729,P=0.186),其余各时点对照组的脊柱后凸Cobb’s角均大于治疗组(t=2.521,P=0.000;t=4.416,P=0.000);时间因素和分组因素之间存在交互效应(F=39.421,P=0.000)。③腰背部疼痛视觉模拟评分。治疗前后不同时间腰背部疼痛视觉模拟评分的差异有统计学意义,即存在时间效应[治疗组:(8.62±1.53)分,(2.05±1.64)分,(1.52±1.24)分;对照组:(8.58±1.73)分,(2.41±1.74)分,(1.78±1.36)分;F=29.361,P=0.003];2组患者腰背部疼痛视觉模拟评分的组间差异总体上有统计学意义,即存在分组效应(F=1.104,P=0.032);除治疗前外(t=0.482,P=0.763),其余各时点对照组的腰背部疼痛视觉模拟评分均大于治疗组(t=1.116,P=0.024;t=1.048,P=0.041);时间因素和分组因素之间存在交互效应(F=30.821,P=0.013)。④Oswsetry功能障碍指数评分。治疗前后不同时间Oswsetry功能障碍指数评分的差异有统计学意义,即存在时间效应[治疗组:(79.68±4.21)分,(30.36±4.83)分,(21.23±4.61)分;对照组:(78.74±4.61)分,(33.72±5.72)分,(24.28±4.42)分;F=33.725,P=0.001];2组患者Oswsetry功能障碍指数评分的组间差异总体上有统计学意义,即存在分组效应(F=3.672,P=0.048);除治疗前外(t=3.227,P=0.281),其余各时点对照组的Oswsetry功能障碍指数评分均大于治疗组(t=7.149,P=0.022;t=4.015,P=0.037);时间因素和分组因素之间存在交互效应(F=26.815,P=0.027)。⑤并发症发生情况。2组患者术中及随访期间均未发生神经、脊髓损伤及感染等并发症。结论:过伸牵引弹性按压法联合经皮椎体成形术治疗骨质疏松性胸腰椎压缩骨折,在恢复伤椎高度、纠正脊柱后凸畸形、缓解腰背部疼痛和恢复脊柱功能方面优于单纯经皮椎体成形术治疗,而且安全性较高。

Objective：To observe the clinical curative effects and safety of hyperextension traction elastic pressure combined with per- cutaneous vertebroplasty（PVP） in the treatment of osteoporotic thoracolumbar vertebral compression fractures. Methods： Ninety patients with osteoporotic thoracolumbar vertebral compression fracture enrolled in the study were randomly divided into 2 groups ,45 cases in each group. All patients in the 2 groups were ordered to stay in hard bed with a soft pillow under the low back. Patients in the treatment group were treated with hyperextension traction elastic pressure eombined with PVP, while the others in the control group were treated with monotherapy of PVP. Anterior border height of injured vertebrae, kyphosis Cobb angle, visual analogue scores （ VAS）, Oswsetry disability in- dex（ODI） and complications were compared between the 2 groups before the treatment and at 24 hrs and 6 months after the treatment re- spectively. Results：There was statistical difference in the anterior border height of injured vertebrae between different time points, in other words, there was time effect（ treatment group： 15.14 ＋/-2.61,26.79 ＋/-2.25,26.68 ＋/-2.53 mm; control group： 15.98 ＋/-2.47,19.85 ＋/- 2.73,19.68 ＋/- 2.59 mm ; F = 22. 532, P = 0.031 ）. There was statistical difference in the anterior border height of injured vertebrae between the 2 groups in general, in other words, there was grouping effect （ F = 5. 421, P = 0.000）. The anterior border height of injured ver- tebrae of control group was less than that of treatment group at posttreatment time points （ t = 4. 063, P = 0. 000 ; t = 6. 124, P = 0.000 ） and there was no statistical difference between them at pretreatment time point（ t = 2. 138 ,P = 0. 261 ）. There was interaction between time fac- tor and grouping factor（F = 35. 835 ,P = 0. 000）. There was statistical difference in kyphotic Cobb angle between different time points, in other words,there was time effect（treatment group：27.86 ＋/- 1.81,8.24 ＋/- 1.37,8.31 ＋/- 1.63 degrees;control group：27.43 ＋/- 1.57,14.62 ＋/- 1.55,14.75 ＋/- 1.48 degrees ; F = 22. 462, P = 0.021 ）. There was statistical difference in kyphotic Cobb angle between the 2 groups in general,in other words, there was grouping effect （ F = 4. 736, P = 0. 000）. The kyphotic Cobb angle of control group was higher than that of treatment group at posttreatment time points （ t = 2. 521, P = 0. 000 ; t = 4. 416, P -- 0. 000） and there was no statistical difference between them at pretreatment time point（ t = 1. 729, P = 0.186）. There was interaction between time factor and grouping factor （F =39.421 ,P =0.000）. There was statistical difference in VAS of lower back pain between different time points,in other words,there was time effect（treatment group：8.62 ＋/- 1.53,2.05 ＋/- 1.64,1.52 ＋/- 1.24 points;control group： 8.58 ＋/- 1.73,2.41 ＋/- 1.74, 1.78 ＋/- 1.36 points ; F = 29. 361, P = 0. 003 ）. There was statistical difference in the VAS of lower back pain between the 2 groups in gen- eral ,in other words ,there was grouping effect（ F = 1. 104 ,P =0. 032）. The VAS of lower back pain of control group was higher than that of treatment group at posttreatment time points （ t = 1.116, P = 0. 024 ; t = 1. 048, P = 0. 041 ） and there was no statistical difference between them at pretreatment time point（ t = 0. 482, P = 0. 763 ）. There was interaction between time factor and grouping factor（ F = 30. 821, P = 0. 013 ）. There was statistical difference in the ODI between different time points, in other words, there was time effect （treatment group： 79.68 ＋/-4.21,30.36 ＋/-4.83,21.23 ＋/-4.61 points;control group：78.74 ＋/-4.61,33.72 ＋/-5.72,24.28 ＋/-4.42 points ; F = 33. 725 ,P---0. 001 ）. There was statistical difference in the ODI between the 2 groups in general, in other words, there was grouping effect （F = 3.672 ,P = 0.048 ）. The ODI of control group was higher than that of treatment group at posttreatment time points （t = 7. 149, P = 0. 022 ; t = 4. 015, P = 0. 037 ） and there was no statistical difference between them at pretreatment time point （ t = 3. 227, P = 0.281 ）. There was interaction between time factor and grouping factor（ F = 26. 815 ,P = 0.027）. No complications such as nerve injury, spinal cord injury and infection were found in the 2 groups. Conclusion ： For treatment of osteoporotic thoracolumbar vertebral compression fractures, the com- bination therapy of hyperextension traction elastic pressure combined with PVP surpasses the monotherapy of PVP in the effect on injured vertebral height restoration, kyphosis correction,lower back pain relief and spinal function restoration, meanwhile it has high safety.