经皮穿刺椎体成形术对骨质疏松性椎体压缩性骨折患者骨钙素水平影响及短期疗效

Effect and short-term efficacy of percutaneous vertebroplasty on osteocalcin level in elderly patients with osteoporotic thoracolumbar fractures

背景:经皮穿刺椎体成形术(percutaneous vertebroplasty,PVP)治疗骨质疏松性胸腰椎骨折的疗效确切,但部分高龄患者容易发生骨不愈合情况。目的:探讨PVP对高龄骨质疏松性胸腰椎骨折患者骨钙素水平、VAS评分的影响及近期疗效。方法:回顾性分析2014年1月至2017年1月我院收治并获得随访的高龄骨质疏松性胸腰椎骨折患者64例,其中接受PVP治疗的34例作为PVP组,进行保守治疗的30例作为保守组。对比分析两组患者治疗前、治疗后1周和治疗后1年的骨钙素水平、VAS疼痛评分、X线片结果(Cobb角、椎体压缩率)、日常生活能力以及并发症发生情况,对患者的近期疗效进行综合评估。结果:治疗后两组患者的疼痛情况均随时间增加而逐渐缓解,但各时间点内PVP组患者的疼痛改善情况均较保守组更为显著(P<0.05);治疗后PVP组患者的骨钙素水平逐渐增加(P<0.05),而保守组患者的骨钙素水平无明显改变(P>0.05),治疗后各检测时间点PVP组患者的骨钙素水平均明显高于保守组(P<0.05);治疗后两组患者的日常生活能力均随时间增加逐渐改善,但各时间点内PVP组患者的改善程度均较保守组更好(P<0.05);治疗后1周两组患者的Cobb角和椎体压缩率均较治疗前有所改善,治疗后1年两组患者的Cobb角和椎体压缩率均较治疗后1周有所恢复,但各时间点内PVP组患者的Cobb角和椎体压缩率改善情况均较保守组更为显著(P<0.05);PVP组患者的并发症发生率(2.9%)明显低于保守组(13.3%);PVP组患者的治疗总有效率(94.2%)明显高于保守组(73.3%),两组间存在明显统计学差异。结论:PVP对于高龄骨质疏松性胸腰椎骨折患者的近期疗效显著,能够有效缓解伤椎的疼痛感,确切修复后凸畸形情况,有效提高患者的生活能力,降低并发症的发生率,是一种较为理想的治疗方案。

Background:Percutaneous vertebroplasty has a definite effect in the treatment of osteoporotic thoracolumbar fractures,but the elderly patients often have bone nonunion.Objective:To investigate the effect of percutaneous vertebroplasty on osteocalcin level and VAS score and short-term efficacy in the treatment of osteoporotic thoracolumbar fractures.Methods:A total of 64 patients with osteoporotic thoracolumbar fractures treated and followed in our hospital were collected from January 2014 to January 2017 including 34 patients receiving percutaneous vertebroplasty as PVP group and 30 patients receiving conservative treatment as conservation group.The levels of osteocalcin,VAS scores,X-ray findings (Cobb angle,vertebral compression rate),daily living ability and complications were measured before the treatment,1 week and 1 year after the treatment.A comprehensive assessment of short-term efficacy was conducted.Results:After the treatment,the pain of the patients in the two groups was gradually alleviated with time progressing,but the improvement of pain in the patients of the PVP group was more significant than that in the conservation group at each time point (P<0.05);the osteocalcin level in the PVP group was gradually increased,nearly no change in the conservation group (P >0.05),and the osteocalcin levels in the PVP group were significantly higher than those in the conservation group at all time point after treatment (P<0.05);the daily living ability of patients in the two groups was gradually improved with time progressing,but the improvement rate of the PVP group was bet- ter than that of the conservation group at each time point (P<0.05);the Cobb angle and vertebral compression rate were improved in the two groups after 1 week of treatment,and furtherly improved after 1year,but the improvement of Cobb angle and vertebral compression rate were more significant in the PVP group than in the conservation group at each time point (P<0.05). The complication rate was significantly lower in the PVP group than in the conservation group (2.9% vs 13.3%,P<0.05)and the total effective rate was significantly higher in the PVP group than in the conservation group (94.2% vs 73.3%,P<0.05). Conclusions:Percutaneous vertebroplasty in the elderly patients has a significant short-term efficacy which can effectively relieve the pain of patients with vertebral injury,repair the kyphosis and improve the living ability of the patients,reduce the in- cidence of complication,and is considered as an ideal treatment.