中医手法结合经皮椎体成形术治疗椎体脆性骨折的临床研究

Clinical Study for Treating Osteoporotic Vertebral Compression Fractures with Percutaneous Vertebroplasty after Manipulative Reduction

目的:为骨质疏松性椎体压缩性骨折(osteoporotic vertebral compression fractures,OVCFs)患者提供一种费用较低、止痛效果好且能有效恢复椎体高度的治疗方法。方法:在2011年3月—2012年9月将过伸牵引震动手法与经皮椎体成形术(percutaneous vertebroplasty,PVP)相结合用于治疗胸腰段脆性骨折,与同期进行的单纯经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)进行随机对照研究,比较两组在手术时间、骨水泥渗漏率、骨水泥注入量、胸腰背部疼痛VAS改善分数、伤椎高度恢复率和节段后凸纠正角度方面的差异。结果:与单纯PKP组比,手法整复结合PVP组手术时间明显延长,但在骨水泥渗漏率、骨水泥注入量、胸腰背部疼痛VAS改善分数、伤椎高度恢复率和节段后凸纠正角度方面没有显著性差异。结论:过伸牵引震动手法与PVP相结合应用于治疗老年人的骨质疏松性椎体骨折是一种安全的,能有效恢复椎体高度,纠正节段后凸畸形角度,且相对于PKP费用大大减少的治疗方法。

Objective：To provide an economical treatment which can effectively restore vertebral body height, and re- lieve pain for osteoporotic vertebral compression fractures （OVCFs）. Method：From March 2011 to September 2012,53 pa- tients underwent percntaneous vertebroplasty （PVP） after manipulative reduction for OVCFs, meanwhile,57 patients un- derwent percutaneous kyphoplasty （PKP） alone. The patients injection amount of bone cement, time and cost of opera- tion, bone cement leakage, Visual Analogue Scale （VAS） improved score, the vertebral body height restoration rate and kyphosis correction degree were recorded and analyzed between the two groups. Result ： Compared to the PKP group, the operation time was significantly more in the PVP after manipulative reduction group （ average 52.53 minutes vs 41.28 mi- nutes,P 〈 0.05） and the cost was far less. The incidence of bone cement leakage among the PVP after manipulative re- duction group was 18.9% ,which was 7.0% among the PKP group. All leaks were asymptomatic ,and there was no signif- icant difference （P 〉 0.05）. There was also no significant differences （P 〉 0. 05 ） with regard to injection amount of bone cement, kyphosis correction degree and VAS improved scores between the two groups. Conclusion：PVP after manip- ulative reduction can effectively relieve pain, restore vertebral body height and correct kyphosis degree for osteoporotic ver- tebral compression fractures （OVCFs）. It is safe and economical.