不同术式对中老年女性骨质疏松性压缩椎体几何学畸形的矫形能力

Ability of geometry deformity correction of different surgical procedures for middle-aged and old women with osteoporotic vertebral compression fractures

目的比较椎体成形术(PVP)和椎体后凸成形术(PKP)对中老年女性骨质疏松性压缩椎体骨折(OVCF)几何学畸形的矫形能力,并探讨椎体几何学畸形完全矫正与临床症状缓解之间的关系。方法选取99例接受椎体成形术(PVP)或椎体后凸成形术(PKP)中老年女性OVCF患者,根据术式分为PVP组(56例)和PKP组(43例)。采用Mc Closkey-Black椎体几何学形态定量判定法测量患者术前及术后的压缩椎体高度参数,整体判断压缩椎体的几何学形态为"正常形态"或"压缩形态",比较压缩椎体几何学形态变化情况及两种术式对几何学异常形态的椎体的矫形能力。同时采用疼痛视觉模拟评分(VAS)比较患者的临床症状缓解情况与几何学畸形完全矫正之间的关系。结果术后共有22例患者的"压缩形态"被矫正为"正常形态",总体矫正率为22.22%。PKP组矫正率高于PVP组,分别为34.15%和14.81%,差异具有统计学意义(P<0.05)。患者术后的VAS评分较术前明显降低(P<0.05);术后几何学畸形完全矫正的患者VAS评分为2.31±0.93,几何学畸形未完全矫正的患者VAS评分为2.60±0.92,差异无统计学意义(P>0.05)。结论PKP和PVP两种微创术式均能显著纠正压缩椎体的几何学畸形形态,PKP对椎体几何学畸形的纠正能力优于PVP;椎体几何学畸形完全矫正与临床症状缓解之间无明显关联。

Objective To compare the ability of geometry deformity correction of percutaneous vertebroplasty（ PVP） and percutaneous kyphoplasty（ PKP） for middle-aged and old women with osteoporotic vertebral compression fractures（ OVCF） and explore the correlation between the complete correction of geometry deformity and the relief of clinical symptoms. Methods A total of 99 middle-aged and old women with OVCF who underwent PVP or PKP were selected and divided into the PVP group（ n = 56） and PKP group（ n = 43） according to the surgical procedure.Mc Closkey-Black quantitative judgment of percutaneous morphometric shape was adopted to measure the height of compressed vertebra before and after surgery. The geometric types of vertebrae were classified into the morphometric normal shape and morphometric compressed shape. The variations of morphometric shapes of compressed vertebrae and the ability of geometry deformity correction of two surgical procedures were compared. The correlation between the complete correction of geometry deformity and the relief of clinical symptoms was compared by the visual analogue scale（ VAS）. Results A total of 22 patients acquired complete morphometric correction after surgery and the overall correction rate was 22. 22%. The correction rate of the PKP group（ 34. 15%） was higher than that of the PVP group（ 14. 81%） and the difference was statistically significant（ P〈0. 05）. The VAS scores of patients after surgery were significantly lower than those before surgery（ P〈0. 05）. The VAS scores of patients with complete and incomplete morphometric correction after surgery were 2. 31 ± 0. 93 and 2. 60 ± 0. 92, respectively. The difference was statistically insignificant（ P〉0. 05）. Conclusion Both minimally invasive PKP and PVP can significantly correct the morphometric deformity of compressed vertebrae. The ability of geometry deformity correction of PKP is better than PVP. There is no clear correlation between the complete correction of geometry deformity and the relief of clinical symptoms.