胸腰椎体压缩性骨折行椎体后凸成形注射骨水泥的治疗时机

Treatment timing for kyphoplasty with bone cement injection in patients with thoracolumbar vertebral compression fractures

背景:相关研究表明,椎体后凸成形注射骨水泥治疗后椎体高度的恢复与受伤时间密切相关,不同时间的手术对患者术后并发症的发生情况也有着重要影响。目的:比较胸腰椎体压缩性骨折2周内及2-4周期间行经皮椎体后凸成形注射骨水泥治疗的临床疗效,探讨经皮椎体后凸成形术的最佳手术时机。方法:纳入82例胸腰椎骨折患者,年龄55-85岁,其中39例于伤后2周内进行经皮椎体后凸成形注射骨水泥治疗,另43例于伤后2-4周期间进行经皮椎体后凸成形注射骨水泥治疗。比较两组治疗后的目测类比评分、伤椎前缘和中部高度恢复情况及伤椎骨水注射量和渗漏情况;治疗后6个月,采用Oswestry功能障碍指数评估两组患者日常活动功能。结果与结论:两组治疗后即刻及6个月的目测类比评分和Oswestry功能障碍指数均低于治疗术前(P<0.05),2周内治疗组治疗后即刻的目测类比评分高于2-4周内治疗组(P<0.05)。两组治疗后6个月的伤椎前缘和中部高度恢复率比较差异无显著性意义,但2周内治疗组伤椎前缘和中部高度丢失率低于2-4周内治疗组(P<0.05)。两组骨水泥注入量与骨水泥渗漏率比较差异无显著性意义。表明2周内行经皮椎体后凸成形注射骨水泥治疗后疼痛明显,但对近期椎体高度丢失率影响较小,因此可作为治疗胸腰椎压缩性骨折的优选治疗时机。

BACKGROUND： Related studies have shown that after kyphoplasty with bone cement injection,the vertebral height restoration is closely related to the injury time. Surgical timing also has an important influence on the incidence of postoperative complications. OBJECTIVE： To compare the clinical efficacy of kyphoplasty with bone cement injection at 2 and 2-4 weeks after thoracolumbar vertebral compression fractures,and to investigate the best timing for kyphoplasty. METHODS： Eighty-two thoracolumbar fracture patients,aged 55-85 years old,were included. Thirty-nine cases were subjected to kyphoplasty with bone cement injection within 2 weeks after injury. Another 43 cases were subjected to kyphoplasty with bone cement injection within 2-4 weeks after injury. The visual analog scale score,restoration of anterior and central vertebral height,volume and leakage of bone cement after treatment werecompared between two groups. At 6 months after treatment,the daily activities of patients in the two groups were evaluated using Oswestry disability index. RESULTS AND CONCLUSION： Immediately and at the 6th month after treatment,the scores on the visual analog scale and the Oswestry disability index were lower than those before treatment（P〈0.05）. The visual analog scale score immediately after treatment in the treatment group within 2 weeks was higher than that in the treatment group within 2-4 weeks（P〈0.05）. After 6 months of treatment,there was no significant difference in the restoration rate of anterior and central vertebral height between these two groups,but the loss rate of the anterior and central vertebral height in the treatment group within 2 weeks was lower than that in the treatment group within 2-4 weeks（P〈0.05）. Bone cement injection volume and leakage rate had no significant differences between two groups. These results demonstrate that patients appeared to have obvious pain after percutaneous kyphoplasty with bone cement injection within 2 weeks,but the percutaneous kyphoplasty with bone cement injection had small influence on the short-term loss rate of vertebral height. Therefore,percutaneous kyphoplasty with bone cement injection with 2 weeks after injury is the optimal treatment timing for patients with thoracolumbar compression fractures.