经皮椎体成形术治疗老年骨质疏松性压缩骨折新鲜与陈旧性骨折的对比研究

Comparative Study on Acute Versus Chronic Osteoporotic Vertebral Compression Fractures with Percutaneous Vertebroplasty

目的回顾性对比研究新鲜与陈旧性骨质疏松性椎体压缩骨折行经皮椎体成形术(percutaneous vertebroplasty,PVP)的临床疗效。方法回顾性分析我科应用经皮椎体成形术治疗的骨质疏松性椎体压缩性骨折患者69例,均为单椎体骨折,其中新鲜骨折(A组)38例,陈旧性骨折(B组)31例。对两组患者的疼痛VAS评分、活动能力评分、椎体高度恢复情况、后凸角度纠正情况及并发症进行比较。结果所有患者均随访超过12个月。A组术前VAS评分8.3±1.1,术后12月1.1±0.6,B组术前5.7±1.4,术后12月3.2±2.0。A组活动能力评分术前术前3.1±0.9,术后12月1.1±0.3,B组术前2.0±0.7术后12月1.4±0.5。组间术前与术后比较,两组间比较差异均有统计学意义(P<0.05)。A组术前椎体前壁和中间高度恢复与B组有统计学差异(P<0.05),A组椎体后壁高度和后凸矫正度数与B组无统计学差异(P>0.05)。并发症:骨水泥渗漏:A组9例;B组7例,A组邻椎骨折3例,两组间比较差异有统计学意义(P<0.05)。结论经皮椎体成形术治疗骨质疏松性椎体新鲜与陈旧性骨折安全有效,新鲜骨折疗效优于陈旧性骨折。

Objective To retrospectively compare the clinical outcomes of percutaneous vertebroplasty in the treatment of acute and chronic osteoporotic vertebral compression fractures. Methods 69 cases were treated by unilateral PVP for osteoporotic vertebral compression fractures. The patients were divided into two groups（acute group and chronic group） according to the course. Group A： 38 cases with acute fractures. Group B： 31 cases with chronic fractures. The VAS score, locomotor activity score, body height and kyphotic angle of vertebral bodies before and after operation were compared between the two groups. Results All patients were followed up for 12 months. VAS score decreased from 8.3±1.1 to 1.1±0.6 and locomotor activity score decreased from 3.1±0.9 to 1.1±0.3 in group A.VAS score decreased from 5.7±1.4 to 3.2±2.0 and locomotor activity score decreased from 2.0±0.7 to 1.4±0.5 in group B. the difference was statistically significant（P〈0.05）. the restoration rate of anterior and middle vertebral height in group A were better than group B after operation（P〈0.05）. There was no difference in the posterior vertebral height and the kyphotic correction rate between two groups prior to treatment and after treatment（P〉0.05）. Cement leakage happened in 9 patients in group A and 7 patients in group B. There were 3 adjacent vertebra fractures in group A. Conclusion The PVP is safe and effective for acute and chronic osteoporotic vertebral compression fractures.The curative effect and satisfaction of patients for acute fractures was better than chronic fractures.