PVP结合应用胸腰骶固定矫形器支具治疗OVCF的疗效

PVP Combined with Thoracolumbar and Sacral Orthosis Brace for The Treatment OVCF

目的探讨经皮椎体成形术（percutaneous vertebroplasty,PVP）结合应用胸腰骶固定矫形器支具固定90 d治疗胸腰椎（T10～L4）骨质疏松性椎体压缩骨折（osteoporotic vertebral compression fractures,OVCF）的临床疗效,并设经皮椎体成形术（percutaneous vertebroplasty,PVP）治疗OVCF为对照组比较疗效。方法整群选取2012年1月—2015年12月南京军区福州总医院第一附属医院采用PVP治疗的112例胸腰椎骨质疏松性OVCF患者的资料,其中PVP组（以下统称为A组）56例,PVP结合应用胸腰骶固定矫形器支具组（以下统称为B组）56例,男39例,女89例;年龄61～93岁,平均（78.6±11）岁。骨折节段：T10 12例,T11 24例,T12 25例,L1 26例,L2 25例,L3 16例。受累节段椎体前缘平均压缩为66%（56%～78%）。全部采用双侧椎弓根基底部穿刺入路手术。记录手术时间、骨水泥注射量,术后及随访时复查DR了解骨水泥分布;比较术前1 d、术后3 d及末次随访视觉模拟评分（visual analog scale,VAS评分）、Oswestry功能障碍指数（ODI）、受累节段椎体前缘高度（anterior height,AH）及Cobb角、手术椎体再骨折及塌陷发生率、相邻节段椎体骨折发生率。结果两组所有患者顺利完成手术。随访3～12个月,术后3 d及末次随访VAS评分、Oswestry功能障碍指数（ODI）、受累节段椎体前缘高度值（anterior height,AH）及Cobb角均较术前明显改善差异无统计学意义（P〉0.05）。A组及B组手术椎体再骨折再塌陷发生率分别为10.71%、0.00%,相邻节段椎体骨折发生率分别为12.50%、0.00%,差异有统计学意义（P〈0.05）。结论 A组及B组治疗胸腰椎骨质疏松性OVCF均可以有效缓解胸背痛、活动能力及功能障碍指数（ODI）,部分恢复受累节段椎体前缘高度及后凸角,但PVP结合应用胸腰骶固定矫形器支具有效预防手术椎体再骨折再塌陷及相邻节段椎体骨折,而A组则不能,故PVP结合应用胸腰骶固定矫形器支具治疗OVCF疗效与PVP相仿,但其在预防手术椎体再塌陷及相邻节段椎体骨折等并发症上有优势,适合治疗OVCF。

Objective To study the percutaneous vertebral plasty（percutaneous vertebroplasty, PVP） combined with thoracic lumbar sacral fixation brace with a fixed 90 d in the treatment of thoracolumbar（T10 ～ L4） osteoporotic vertebral compression fractures（osteoporotic vertebral compression will fractures, OVCF） clinical curative effect, and percutaneous vertebral plasty（percutaneous vertebroplasty, PVP） treatment of OVCF curative effect to be compared to control group. Methods Group selection from January 2012 to December 2012, the First Affiliated Hospital of Fuzhou General Hospital, Nanjing Military Command adopt PVP treatment of 112 cases of patients with thoracolumbar osteoporotic OVCF data, including PVP group（hereinafter referred to as A group） 56 cases, PVP combined with thoracic lumbar sacral fixation brace support group（hereinafter referred to as group B） 56 cases, male 39 cases, 89 cases of female; 61 ～ 93 years old,overage（78.6±11） years old. 12 cases fracture segments： T10, T11, 24 cases, 25 cases of T12, L1 26 cases, 25 cases of L2, L3 in 16 cases. Affected segment fanterior margin compression for an average of 66%（56% ～ 78%）. All adopt bilateral vertebral arch foundation piercing into the road at the bottom of the surgery. Operation time, bone cement injection volume, postoperative and followup review DR know bone cement distribution; Compared preoperative 1 d, 3 d and after the last follow-up visual analogue scale（visual analog scale, VAS score）, activity ability score（level 4 score method） and Oswestry disability index（ODI）, surgical vertebral fractures and subsidence rate, incidence of adjacent segment vertebral fractures. Results All patients were successfully completed surgery in both groups. Followed up for 3 ～ 12 months, 3 d and postoperative VAS score, the last follow-up Oswestry disability index（ODI）, the affected segment fanterior flange height value（anterior height, AH） and Cobb Angle compared with preoperative obviously improve but no statistical difference（P 〉0.05）. Group A and group B surgery vertebral fracture then collapse rate were 10.71%, 0.00%, incidence of adjacent segment vertebral fractures were 12.50%,0.00% have statistical difference（P〈0.05）. Conclusion Group A and group B in the treatment of thoracolumbar osteoporotic OVCF can effectively relieve chest pain, and disability index（ODI）, partial involvement after segmental fanterior flange height and convex Angle, but with A PVP combined with thoracic lumbar sacral fixation brace effectively prevent surgical vertebral fracture and collapse and adjacent segmental vertebral fracture, the group A is not, therefore, PVP treated with A combined with thoracic lumbar sacral fixation brace OVCF efficacy as A PVP, but their in preventing surgical vertebral body collapse, and adjacent segmental vertebral fracture has the advantages on complications, such as suitable for treatment of OVCF.