经皮椎体后凸成形术(PKP)在骨质疏松性椎体压缩骨折中的应用

Application of PKP in osteoporotic vertebral compression fractures

目的：探讨经皮椎体后凸成形术（PKP﹚在骨质疏松性椎体压缩骨折中的应用。方法选取2011年1月-2013年12月我院骨科行手术治疗的骨质疏松性椎体压缩骨折患者68例。采用随机数字表将选取的68例患者分为PKP组（n=34﹚和PVP组（n=34﹚,分别采用PKP和PVP方法进行手术治疗。观察两组患者的手术时间、骨水泥注入量、骨水泥渗漏和疼痛缓解情况,随访术后1个月椎体压缩率和Cobb＇s角恢复情况。结果 PVP组患者的单个椎体手术时间和骨水泥注入量明显少于PKP组（P〈0.05﹚。PVP组发生骨水泥渗漏14例（41.18%﹚,PKP组发生骨水泥渗漏6例（17.65%﹚,PVP组骨水泥渗漏发生率明显高于PKP组（χ^2=4.53,P〈0.05﹚。术后1周,两组患者VAS疼痛评分均较术前明显下降（P〈0.01﹚,两组患者VAS疼痛评分下降值比较差异无统计学意义（P〉0.05﹚。术后1月,两组患者椎体压缩率和Cobb＇s角均较术前改善（P〈0.05或P〈0.01﹚,且PKP组改善率明显优于PVP组（P〈0.05﹚。结论 PVP和 PKP治疗骨质疏松性椎体压缩骨折的止痛效果均较好,均能有效地缓解患者的疼痛症状,PKP能更好地恢复椎体高度,减少骨水泥渗漏的发生率。

Objective To discuss the application of PKP in osteoporotic vertebral compression fractures. Methods A total of 68 cases of patients with osteoporotic vertebral compression fractures were given the operative medical treat-ment in our hospital’s department of orthopedics during the period from January 2011 to December 2013, they were selected and divided into PKP group（n=34） and PVP group（n=34） by table of random number, and given PKP and PVP operation respectively. The operation time, bone cement injection volume, leakage and easement of pain of patients in two groups were observed and compared, and the recovery of vertebral compression rate and Cobb＇s angle was followed up one month after the operation as well. Results Each centrum operation time and bone cement injection volume of patients in PVP group were obviously lower or less than those in PKP group （P〈0.05）. 14 and 6 cases of bone cement leakage appeared in PVP group （41.18%） and PKP group （17.65%） respectively, and the occurrence rate of bone cement leakage of patients in PVP group was much higher than that in PKP group （χ2=4.53, P〈0.05）. One week after the opera-tion, the VAS scores of patients in two groups obviously declined than before（P〈0.01）, and compared the declining rates of VAS scores of patients in two groups, there were no obvious differences appeared （P〉0.05）. The vertebral compression rate and Cobb＇s angle of patients in two groups were obviously improved than before （P〈0.05 or P〈0.01）, and the improve ment rate in PKP group was much better than that in PVP group （P〈0.05）. Conclusion PVP and PKP have favorable cu-rative effect on analgesic effect of osteoporotic vertebral compression fractures, which can effectively relieve the pain symptoms, while PKP can recover the vertebral height better, reduce the occurrence rate of bone cement leakage with higher security.