椎体后凸成形术后的不同治疗对骨质疏松性骨折疗效的影响

Effects of different treatments on patients with osteoporotic fracture after percutaneous kyphoplasty

目的:探讨椎体后凸成形术后的不同治疗方案对骨质疏松性骨折患者疼痛和功能的影响。方法 :将2010年3月至2012年3月收治的138例(165椎)胸腰椎椎体骨质疏松性骨折患者随机分为3组(对照组、治疗组和综合组),每组46例,均采用PKP治疗。对照组术后采用钙剂配合骨化三醇治疗;治疗组在对照组方案基础上,加用鲑鱼降钙素肌注治疗;综合组在治疗组方案基础上,督促患者渐进性腰背肌功能锻炼。分别在术前,术后3 d、2周,1、6、12个月进行疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI评分)及BMD检测。结果 :所有患者手术顺利,其中对照组38例(45椎)、治疗组36例(44椎)、综合组40例(49椎)获得完整随访,各组患者的随访率比较差异无统计意义(P>0.05)。与术前相比较,各组术后不同时期的VAS和ODI评分均明显降低(P<0.01);与对照组比较,治疗组和综合组在术后3 d、2周、1个月的VAS评分均降低(P<0.05),而各组间ODI评分比较差异无统计学意义(P>0.05);术后6、12个月,对照组与治疗组的VAS、ODI评分比较差异无统计学意义(P>0.05),而综合组的VAS评分与对照组和治疗组比较明显降低(P<0.05),且综合组的ODI评分呈持续下降(P<0.01);术后12个月,各组患者的BMD与术前比较均有所升高(P<0.01),其中综合组的BMD明显高于对照组和治疗组(P<0.05)。结论:PKP是治疗胸腰椎椎体骨质疏松性骨折的有效方法,术后系统使用降钙素联合钙剂、活性维生素D有助于提高PKP术后的短期疗效,而坚持腰背肌功能锻炼能提高PKP的长期疗效,改善患者的生活质量。

Objective：To evaluate effects of different treatments on patients with osteoporotic vertebral fracture after percutaneous kyphoplasty in pain and function. Methods：From March 2010 to March 2012,138 patients（165 vertebrae） with thoracic and lumbar vertebral osteoporotic fracture were randomly divided into three groups（control group,treatment group and comprehensive group）,46 cases in each group,and all patients were treated by PKP. Control group were treated with calcium and calcitriol after operation,treatment group added salmon calcitonin see calcimar based on control group,comprehensive group added incrementality waist musculi dorsi function exercise based on treatment group. VAS,ODI scores and BMD before operation,3 d,2 weeks,1 month,6 months and 12 months after operation were detected and compared. Results：All operation were performed successfully,38 cases（45 vertebrae） in control group,36 cases（44 vertebrae） in treatment group and 40 cases（49 vertebrae） were obtained complete following up,there was no significant meaning in following time among three groups（P0.05）. Postoperative VAS and ODI scores at 3 d,2 weeks and 1 month among three groups were lower than that of before operation（P 0.01）. Compared with control group,postoperative VAS score at 3 d,2 weeks and 1 month were decreasedin treatment group and comprehensive group,but there was no significant meaning in ODI scores（P0.05）. At 6 and 12 months after operation,there was no significant differences in VAS and ODI between control group and treatment group（P 0.05）,while VAS score in comprehensive group decreased much than other two groups,decreased continuously（P 0.01）. At 12 months after operation,BMD among three groups were increased more than preoperative,and BMD in comprehensive group was more obviously than that of in control and treatment group. Conclusion：PKP,an effective method for the treatment of thoracic and lumbar vertebral osteoporotic fracture,could improve short term clinical effects by adding calcitonin with calcium supplements and activated vitamin D. Waist musculi dorsi function exercise could improve long term clinical effects of PKP and improve quality of life.