28例椎体后凸成形术后邻近椎体骨折的治疗观察

Therapeutic observations on 28 cases of adjacent vertebral fractures after PKP

目的探讨骨质疏松性椎体压缩骨折(osteoporosis vertebral compress fracture,OVCF)患者椎体后凸成形术(percutaneous kyphoplasty,PKP)后邻近椎体骨折再行PKP、椎体成形术(percutaneous vertebroplasty,PVP)治疗的临床疗效。方法将2012年1月~2015年2月青海省人民医院收治的28例行PKP术后发生邻近椎体骨折患者,随机分为两组,其中再行PVP术患者(A组)16例,男性4例,女性12例;年龄58~89岁,平均69.8岁;同期收治的行PKP术后发生邻近脊椎骨折再行PKP术患者(B组)12例,男性3例,女性9例;年龄56~86岁,平均67.6岁。统计分析A、B组邻近椎体骨折行PKP、PVP术前、术后2d、随访时视觉模拟评分(VAS),以及发生第二次邻近脊椎骨折个数。结果 A组再次手术前、术后2d、末次随访时VAS评分分别为(7.9±1.6)分、(2.0±0.9)分、(2.9±1.1)分;B组再次手术前、术后2d、末次随访时VAS评分分别为(7.8±1.7)分、(2.0±0.7)分、(2.2±0.8)分。两组术后2d、末次随访时VAS评分均明显低于术前(P<0.01)。A组末次随访时VAS高于术后2d(P<0.05),B组随访时与术后2d的VAS评分无明显差异(P>0.05)。末次随访时A组VAS评分高于B组(P<0.05),两组间术前以及术后2d的VAS评分均无统计学差异。末次随访时A组有4例发生第2次及以上的邻近脊椎骨折;而B组只有1例发生第2次及以上的邻近脊椎骨折;两组发生的邻近脊椎骨折均位于初发骨折邻近3个脊椎以内。结论骨折邻近3个脊椎是PKP术后好发骨折的部位,PVP和PKP是治疗PKP术后邻近椎体骨折的有效手段;邻近椎体骨折行PKP发生再次邻近椎体骨折的几率比PVP低。

Objective To discuss the clinical efficacy of percutaneous kyphoplasty（PKP） and percutane- ous vertebroplasty（PVP） on adjacent vertebral fractures in osteoporotic vertebral compression fracture （OVCF） pa- tients after PKP. Methods Twenty-eight patients of adjacent vertebral fractures after PKP admitted from Jan. 2012 to Feb. 2015 in our hospital were selected. Sixteen patients [4 males and 12 females aged from 58 to 89 （av- erage,69. 8） years] accepting PVP for the treatment were taken as Group A; while other 12 cases [3 males and 9 females aged from 56 to 88 （average,67. 6） years ] accepting PKP for the treatment were classified into Group B. Statistical analyses were completed for Visual Analogue Scale（VAS） scores and the number of subsequent adjacent vertebral fractures of patients in both groups before and 2 days after PKP and PVP as well as during follow-up visits. Results The VAS scores of pre-operation,2 days after surgery and final follow-up visit for Group A were （7.9 ± 1.6）, （2.0 ±0. 9） and （2.9± 1.1 ） ,respectively; while the VAS scores of pre-operation,2 days after surgery and the final follow-up visit for Group B were （7.8 ± 1.7 ）, （ 2. 0 ± 0. 7 ） and （2. 2 ±0. 8 ）, respectively. The VAS scores of 2 days after surgery and the final follow-up visit for both groups were significantly lower than those of pre- operation（P 〈0. 01 ）. The VAS score of the final follow-up visit in Group A was higher than that of 2 days after sur- gery （ P 〈 0. 05 ）, while there was no significant difference between the VAS scores of follow-up visits and 2 days after surgery in group B （P 〉 0.05）. The VAS score of Group A was higher than that of Group B during the final follow- up visit（P 〈 0.05）, and no statistical difference was found in VAS scores of pre-operation and 2 days after surgery between the two groups. During the final follow-up visit ,four cases in Group A were suffering from adjacent vertebral fractures for a second or third time ; however, there was only one case in Group B who was confronting the same situ- ation; and the adjacent vertebral fractures in both groups occurred within 3 spines adjacent to the initial vertebral fracture. Conclusion The 3 spines adjacent to the initial fracture were the predilection sites of vertebral fractures after PKP. Both PVP and PKP were effective methods for the treatment of adjacent vertebral fractures after PKP.However, the probability of a subsequent fracture after the treatment of PKP is lower than that of PVP.