球囊扩张部位对椎体后凸成形术治疗骨质疏松性椎体压缩骨折疗效及安全性的影响

Influence of balloon dilation position on curative effect and safety of percutaneous kyphoplasty for treatment of osteoporotic vertebral compression fractures

目的:探讨经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCF)时,球囊扩张部位对手术疗效及安全性的影响。方法:回顾性分析47例采用PKP治疗的新鲜单节段OVCF患者的病例资料。24例球囊扩张部位位于骨折线处(骨折线组),其余23例球囊扩张部位未位于骨折线处(非骨折线组)。比较2组患者的伤椎前缘高度、疼痛视觉模拟量表(visual analogue scale,VAS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)评分及治疗、随访期间的并发症发生情况。结果:所有患者均顺利完成手术,未发生脊髓、神经根损伤及肺栓塞等并发症;9例发生骨水泥渗漏,其中骨折线组3例向侧前方渗漏、2例向椎间盘渗漏,非骨折线组向侧前方和椎间盘渗漏各2例,9例患者均未出现临床症状。2组患者并发症发生率比较,差异无统计学意义(χ~2=0.000,P=1.000)。手术前后不同时间伤椎前缘高度的差异有统计学意义,即存在时间效应(F=117.624,P=0.000);2组患者伤椎前缘高度总体上比较,组间差异有统计学意义,即存在分组效应(F=4.127,P=0.048);除术前外[(18.69±3.17)mm,(18.70±2.96)mm,t=0.451,P=0.654],术后3d和术后3个月时骨折线组的伤椎前缘高度均大于非骨折线组[(21.56±1.57)mm,(20.30±1.98)mm,t=2.127,P=0.039;(21.42±1.54)mm,(20.14±2.00)mm,t=2.145,P=0.037]。时间因素与分组因素存在交互效应(F=9.808,P=0.003)。手术前后不同时间疼痛VAS评分的差异有统计学意义,即存在时间效应(F=760.314,P=0.000);2组疼痛VAS评分总体上比较,组间差异有统计学意义,即存在分组效应(F=4.911,P=0.032);除术前外[(7.96±0.86)分,(7.78±0.95)分,t=0.665,P=0.509],术后3d和术后3个月时骨折线组的疼痛VAS评分均小于非骨折线组[(2.41±0.88)分,(2.95±0.93)分,t=2.046,P=0.047;(2.08±0.78)分,(2.56±0.73)分,t=2.194,P=0.033]。时间因素与分组因素存在交互效应(F=3.119,P=0.049)。手术前后不同时间ODI评分的差异有统计学意义,即存在时间效应(F=2018.591,P=0.000);2组ODI评分总体上比较,组间差异有统计学意义,即存在分组效应(F=4.168,P=0.047);除术前外[(39.54±2.23)分,(39.13±1.94)分,t=0.674,P=0.504],术后3d和术后3个月时骨折线组的ODI评分均小于非骨折线组[(22.67±1.90)分,(24.35±2.32)分,t=2.716,P=0.009;(14.38±1.58)分,(15.61±1.44)分,t=2.793,P=0.008]。时间因素与分组因素存在交互效应(F=4.014,P=0.021)。结论:采用PKP治疗OVCF时,在骨折处进行球囊扩张更有利于恢复伤椎高度、减轻疼痛、恢复功能,并且具有较高的安全性。

Objective：To explore the influence of balloon dilation position on curative effect and safety of percutaneous kyphoplasty（PKP） for treatment of osteoporotic vertebral compression fractures（OVCF）.Methods：The medical records of 47 patients with fresh singlesegment OVCF who were treated with PKP were analyzed retrospectively.The dilated balloon was placed at fracture line for 24 patients（fracture line group） and at other position for 23 patients（non-fracture line group）.The injured vertebrae anterior border height pain visual analogue scale（VAS） scores,Oswestry disability index（ODI） scores and complications during the treatment period and follow- up period were compared between the 2 groups.Results：The surgery were finished successfully in all patients and no complications such as spinal cord injuries,nerve- root injuries and pulmonary embolism were found.The bone cement leakage were found in 9 patients,whlie no patient developed clinical symptoms.Anterolateral leakage（3） and leakage into intervertebral disc（2） were found in fracture line group,while anterolateral leakage（2） and leakage into intervertebral disc（2） were found in non- fracture line group.There was no statistical difference in complication incidences between the two groups（Χ2 =0.000,P = 1.000）.There was statistical difference in the injured vertebrae anterior border height between different timepoints,in other words,there was time effect（F = 117.624 P =0.000）.There was statistical difference in injured vertebrae anterior border height between the 2 groups in general,in other words,there was group effect（F = 4.127 P =0.048）.There was no statistical difference in injured vertebrae anterior border height between the 2 groups before the surgery（18.69 ＋/- 3.17 vs18.70 ＋/-2.96 mm f = 0.451,P = 0.654）.The injured vertebrae anterior border height were higher in fracture line group compared to non-fracture line group at 3 days and 3 months after the surgery（21.56 ＋/- 1.57 vs 20.30 ＋/- 1.98 mm,t=2.127 P =0.039;21.42 ＋/-1.54 vs 20.14 ＋/-2.00 mm,t=2.145,P=0.037）.There was interaction between time factor and group factor（F =9.808,P=0.003）.There was statistical difference in the pain VAS scores between different timepoints,in other words,there was time effect（F =760.314 P =0.000）.There was statistical difference in pain VAS scores between the 2 groups in general,in other words,there was group effect（F =4.911 P =0.032）.There was no statistical difference in pain VAS scores between the 2 groups before the surgery（7.96 ＋/-0.86 vs7.78 ＋/- 0.95 points,t = 0.665 P = 0.509）.The pain VAS scores were less in fracture line group compared to non- fracture line group at3 days and 3 months after the surgery（2.41 ＋/- 0.88 vs 2.95 ＋/- 0.93 points,t = 2.046,P =0.047;2.08 ＋/- 0.78 vs 2.56 ＋/- 0.73 points,t = 2.194,P = 0.033）.There was interaction between time factor and group factor（F = 3.119,P = 0.049）.There was statistical difference in the ODI scores between different timepoints,in other words,there was time effect（F =2 018.591 P =0.000）.There was statistical difference in ODI scores between the 2 groups in general,in other words,there was group effect（F =4.168 P =0.047）.There was no statistical difference in ODI scores between the 2 groups before the surgery（39.54 ＋/- 2.23 vs 39.13 ± ＋/- 1.94 points,t = 0.674 P =0.504）.The ODI scores were less in fracture line group compared to non- fracture line group at 3 days and 3 months after the surgery（22.67 ＋/- 1.90 vs 24.35 ＋1-2.32 points,t =2.716 P =0.009;14.38 ＋/- 1.58 vs 15.61 ＋/- 1.44 points,t =2.793 P =0.008）.There was interaction between time factor and group factor（F =4.014 P =0.021）.Conclusion：The balloon dilatation at fracture sites is conducive to alleviating pain and recovering height and function of injured vertebrae with high safety in treatment of OVCF by PKP.