经皮后凸成形术联合抗骨质疏松药物治疗老年骨质疏松性胸腰椎骨折的效果观察

Clinical efficacy of percutaneous kyphoplasty combined with anti-osteoporosis drugs treatment of vertebral compression fracture with osteoporosis in elderly patients

目的探讨经皮后凸椎体成形术联合抗骨质疏松药物治疗老年骨质疏松性胸腰椎骨折的效果。方法选择我院2010年lO月至2014年12月收治的老年骨质疏松性胸腰椎骨折患者53例，将53例患者随机分为治疗组（27例）和对照组（26例）。两组患者均给予经皮后凸成形术（PKP），治疗组术后同时给予抗骨质疏松治疗。比较两组患者手术前及手术后VAS、后凸畸形Cobb’s角的变化。观察两组患者术后并发症及术后6个月骨密度水平。结果治疗组与对照组手术前VAS分别为（7．92±1．00）、（7．89±0．99）分，手术后1周分别为（2．68±1．01）、（2．73±1．03）分，两组患者手术后1周VAS与术前比较差异均有统计学意义（P值分别为0．037、0．038），手术前、后组间比较差异均无统计学意义（P均〉0．05）。治疗组与对照组手术前后凸Cobb’s角分别为（28．23±6．00）°、（28．10±5．99）°，手术后分别为（10．90±2．99）°、（11．09±3．00）°，两组手术后与手术前比较差异均有统计学意义（P值分别为0．027、0．029），手术前、后组间比较差异均无统计学意义（P均〉0．05）。对照组术后6个月骨密度为（0．65±0．06）g／cm^2，治疗组抗骨质疏松治疗6个月后骨密度为（0．79±0．12）g／cm^2，两组比较差异有统计学意义（P=0．048）。术后随访12个月，对照组患者新发椎骨骨折4例（15．4％，4／26），治疗组未发生新的椎骨骨折，两组再发骨折发生率比较差异有统计学意义（P=0．041）。结论PKP联合抗骨质疏松治疗老年骨质疏松性椎体骨折，能快速缓解骨质疏松性椎体骨折的疼痛，具有创伤小、矫形效果明显及降低新发椎骨骨折发生率等优点，值得临床推广应用。

Objective To investigate the clinical effect of percutaneous kyphoplasty（PKP） combined with anti-osteoporosis drug treatment of vertebral compression fracture with osteoporosis in elderly patients. Methods Fifty-three cases of elderly patients with thoracolumbar vertebral compression fracture due to osteoporosis were selected as subjects, who were hospitalized in the Central Hospital of Sujiatun District of Shenyang from October 2010 to December 2014. They were randomly divided into the observation group （ 27 cases） and control group（ 26 cases） . All patients were treated with PKP. The patients in the observation group were given the anti-osteoporosis therapy. Before and after operation, the visual analogue scale（VAS） score was estimated and Cobb＇s angle of the vertebrae were measured. Postoperative complications, bone mineral density in the first half year after operation were recorded. Results VAS of treatment and of control group before operation were 7.92±1.00 and 7.89±0. 99, higher than those of one week after operation （ 2. 68±1.01, 2. 73±1.03）. Two groups of treatment and control had no significant difference（ P〉0. 05） , but before and one week after operation had significant difference （P = 0. 037, 0. 038）. Cobb＇s angle of treatment and control group were （28.23±6. 00）° and （28. 10±5. 99）° before operation, （10. 90±2. 99）° and （11.09±3.00）° one week after operation. Two groups of treatment and control had no significant difference （P〉0.05）, but before and one week after operation had significant difference （ P = 0. 027, 0. 029 ）. The bone mineral density in observation group was （0. 79±0. 12） g/cm^2, higher than that in control group（ （0. 65±0. 06） g/cm^2, P=0. 048） in sixth months after operation. The duration of follow up after operetion were 12 months. Recurrence rate of vertebral compression fracture in control group was 15.4% （ 4/26 ）, higher than that in observation group （ 0 （ 0/26 ） ）, and there was significant difference between two groups （ P = 0. 041 ） . Conclusion PKP combined with anti- osteoporosis treatment of vertebral compression fracture with osteoporosis can quickly relieve vertebral fracture pain and reduce the incidence of new vertebral fractures hair. The treatment with minimally invasive and orthopedic effect is worthy of clinical application.