椎体压缩性骨折高度恢复与治疗效果的相关性研究

Association of vertebral height restoration in osteoporotic vertebral compression fractures with clinical results

目的评价经皮椎体成形术、经皮椎体球囊扩张后凸成形术、保守疗法治疗OVCF的近期临床疗效,探讨椎体高度恢复与疼痛程度的相关性。方法将符合条件的并进行相关治疗的患者分成:经皮椎体成形术(PVP)组和经皮后凸成形术(PKP)组,保守治疗组,每组选取15例患者。采用VAS、ODI评分标准和影像资料分别评估,对比分析组之间的疗效、影像资料变化,并分析椎体高度恢复与治疗效果的相关性。结果①PVP、PKP组椎体高度的恢复效果显著;②两组早期止痛效果确切,有助于患者早期恢复日常生活,但远期疼痛缓解效果与保守治疗组相当;③骨折椎体前缘高度压缩程度与疼痛有一定的相关性,治疗后椎体前缘高度恢复程度与疼痛的缓解无相关性;④PVP手术过程中发生了4例骨水泥渗漏、PKP组2例,术后随访发生了4例椎体再骨折。保守治疗组在卧床恢复期间出现肺部感染2例、褥疮2例。结论骨折椎体前缘高度压缩程度与疼痛有一定的相关性,压缩骨折椎体中等程度压缩时疼痛值相对较高;手术后椎体前缘高度恢复程度与疼痛的缓解无相关性。PVP与PKP手术治疗后中短期临床疗效优于保守疗法;保守疗法在经济性及安全性有较大优势。

Objective To assess the results of PVP,PKP and conservative therapy for the treatment of osteoporotic vertebral compression fractures with the pain degree and vertebral body height recovery. Methods A retrieval data for osteoporotic compression fractures was analyzed. Forty-five patients were included in the study and were assigned to three groups,percutaneous vertebroplasty（PVP）group,percutaneous kyphoplastygroup（PKP）group and conservative therapy,15 cases in each group.Clinical effects and Visual analogue scales（VAS）,Oswsetry Disability Indexs（ODI）were recorded,and evaluated by follow-up. Results Restoration of vertebral height of anterior-wedge fracture was remarkable. Postoperative analgesic effect in PVP and PKP group was better than that of conservation treatment group,but there were not significant differences in the long- term pain relief effect between three groups. There were correlation between pain score with compression degree of anterior-wedge of vertebral body. There were four cases of bone cement leakage in PVP group during operation,and two cases in PKP group. In conservation group,pulmonary infection and bed-sore occurred in each two cases during.Conclusion Anterior wedge compression fractures in vertebrae was associated with moderate pain degree. PVP and PKP were superior to conservative treatment in short and medium term after operation.