骨质疏松性椎体压缩骨折不同时期保守和微创治疗的疗效比较

Efficacy Comparison Between Conservative Treatment and Minimally Invasive Treatment in Different Time Periods of Osteoporotic Vertebral Compression Fracture

背景我国医改逐步实行分级诊疗,老龄化社会中骨质疏松性椎体压缩骨折（OVCF）患者增多。保守治疗和微创治疗是主要治疗方法,治疗方法和时期不同,效果有差异,以此为临床医生选择治疗方法提供参考。目的比较微创治疗和保守治疗对OVCF不同时期患者治疗效果的差异。方法收集2009年1月—2014年1月在广州医科大学附属第三医院骨外科住院治疗的临床资料完整且有随访资料的OVCF患者197例,以受伤到医院接受正规治疗的时间为标准,将患者分为0~7 d治疗组（A组,79例）、8~21 d治疗组（B组,60例）、〉21 d治疗组（C组,58例）。再根据住院期间患者所采用的治疗方法,将各组中采用经皮椎体成形术（PVP）或经皮椎体后凸成形术（PKP）治疗者分为微创亚组,将采用体位复位、支具固定、功能锻炼、药物治疗而没有采用PVP或PKP治疗者分为保守亚组。观察不同时期采用不同方法治疗的患者治疗前及治疗后24 h、1周、末次随访的视觉模拟评分（VAS）、Oswestry功能障碍指数问卷（ODI）评分、治疗期间并发症的发生情况。结果 A组：两亚组治疗前后VAS、ODI评分时间与组间存在交互作用（P〈0.05）;时间比较：治疗前后VAS、ODI评分比较,差异有统计学意义（P〈0.05）;组间比较：治疗后24 h、7 d、末次随访,两亚组VAS、ODI评分比较,差异有统计学意义（P〈0.05）。微创亚组并发症发生率为7.1%（3/42）,低于保守亚组的37.8%（14/37）（χ2=10.974,P〈0.05）。B组：两亚组治疗前后VAS、ODI评分时间与组间存在交互作用（P〈0.05）;时间比较：治疗前后VAS、ODI评分比较,差异有统计学意义（P〈0.05）;组间比较：治疗后24 h、7 d、末次随访,两亚组VAS比较,差异有统计学意义（P〈0.05）;两亚组ODI评分比较,差异无统计学意义（P〉0.05）。微创亚组并发症发生率为6.7%（2/30）,低于保守亚组的43.3%（13/30）（χ2=10.756,P〈0.05）。C组：两亚组治疗前后VAS、ODI评分时间与组间存在交互作用（P〈0.05）;时间比较：治疗前后VAS、ODI评分比较,差异有统计学意义（P〈0.05）;组间比较：治疗后24 h、7 d、末次随访,两亚组VAS、ODI评分比较,差异无统计学意义（P〉0.05）。微创亚组并发症发生率为7.1%（2/28）,低于保守亚组的30.0%（9/30）（χ2=4.923,P〈0.05）。结论 OVCF患者在损伤后21 d内进行微创治疗的效果优于保守治疗,而超过21 d进行治疗时微创和保守治疗在疼痛缓解和功能恢复方面差异不明显,但微创治疗并发症发生率低于保守治疗。

Background The classification of diagnosis and treatment has been gradually carried out in the medical reform in China. In the aging population of China, the number of patients with osteoporotic vertebral compression fracture（ OVCF） has been increasing. Conservative treatment and minimally invasive treatment are the primary treatment methods for the disease,while they have efficacy differences in different time periods, which may provide a reference for clinical doctors.Objective To compare the therapeutic efficacy of minimally invasive treatment with that of conservative treatment in different periods of OVCF. Methods We collected the clinical data and follow-up data of 197 OVCF patients who received hospitalizedtreatment in the Third Affiliated Hospital of Guangzhou Medical University from January 2009 to January 2014. According to the time range from getting injured to the beginning of formal treatment,the patients were divided into three groups： 0-7 d group（ group A,n = 79）,8-21 d group（ group B,n = 60） and 21 d group（ group C,n = 58）. According to the treatment method used,the patients who received percutaneous vertebroplasty（ PVP） or percutaneous kyphoplasty（ PKP） were assigned into minimal invasion subgroup,and the patients who received postural reduction,braces fixation,functional exercise and drug therapy instead of PVP or PKP were assigned into conservation subgroup. Data about VAS,ODI score and complications were collected before treatment,24 hours after treatment,1 week after treatment and in the last follow-up visit. Results In group A,interaction effect was found between the two subgroups before and after treatment in VAS and ODI score by temporal comparison and inter-group comparison（ P 0. 05）; by temporal comparison, VAS and ODI score after treatment were significantly different from those before treatment（ P 0. 05）; by inter-group comparison,24 h,7 d after treatment and at last follow-up,the two subgroups were significantly different in VAS and ODI score irrespective of measuring time（ P 0. 05）;the complication incidence of minimally invasive subgroup was 7. 1%（ 3 /42）,lower than that of conservation group,which was37. 8%（ 14 /37）（ χ2= 10. 974,P 0. 05）. In group B,interaction effect was found between the two subgroups before and after treatment in VAS and ODI score by temporal comparison and inter-group comparison（ P 0. 05）; by temporal comparison,VAS and ODI score after treatment were significantly different from those before treatment（ P 0. 05）; by inter-group comparison,the two subgroups were significantly different in VAS 24 h,7 d after treatment and at last follow-up（ P 0. 05）,and were not significantly in ODI score（ P 0. 05）; the complication incidence of minimal invasion subgroup was6. 7%（ 2 /30）,lower than that of conservation group,which was 43. 3%（ 13 /30）（ χ2= 10. 756,P 0. 05）. In group C,interaction effect was found between the two subgroups before and after treatment in VAS and ODI score by temporal comparison and inter-group comparison（ P 0. 05）; by temporal comparison, VAS and ODI score after treatment were significantly different from those before treatment（ P 0. 05）; by inter-group comparison,the two subgroups were not significantly different in VAS and ODI score 24 h,7 d after treatment and at last follow-up（ P 0. 05）; the complication incidence of minimally invasive subgroup was 7. 1%（ 2 /28）,lower than that of conservation group,which was 30. 0%（ 9 /30）（ χ2= 4. 923,P 0. 05）. Conclusion The efficacy of minimally invasive treatment within 21 days after injury is better than conservative treatment for osteoporotic vertebral compression fracture,while the two therapies have no obvious differences in relieving pain and restoring function in more than 21 days after injury, yet the complication incidence by minimally invasive treatment is lower than conservative treatment.