体位复位结合高黏骨水泥椎体成形术治疗骨质疏松性椎体压缩骨折的疗效观察

Treatment of osteoporotic vertebral compression fractures by using high viscosity bone cement combined with hyperextension body position

目的探讨体位复位结合高黏骨水泥椎体成形术治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCF)的临床疗效。方法回顾性分析2012年3月至2015年10月于我院接受治疗的单椎体OVCF病人159例,其中经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗的56例病人纳入PVP组,采用经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗的51例病人纳入PKP组,经体位复位结合高黏骨水泥椎体成形术治疗的52例病人纳入高黏骨水泥组,比较三组病人的疼痛视觉模拟量表(visual analogue scale,VAS)评分、椎体后凸Cobb角以及术后椎体高度恢复率、骨水泥渗漏率等指标。结果 PVP组、PKP组、高黏骨水泥组病人的骨水泥渗漏率分别为14.3%、5.9%、5.8%,PVP组显著高于其他两组(χ~2=30.792,P=0.021;χ~2=37.831,P=0.016);三组病人术后的椎体高度恢复率分别为(36.0±2.9)%、(75.0±3.3)%、(79.0±3.6)%,PVP组显著低于其他两组(t=3.886,P=0.012;t=3.996,P=0.008);PKP组和高黏骨水泥组术后的Cobb角均较术前显著改善(t=34.096,P=0.001;t=33.201,P=0.001),但PVP组术后未见明显改善;三组病人术后的VAS评分均较术前评分显著改善(P<0.05)。结论体位复位结合高黏骨水泥椎体成形术治疗OVCF,可以取得与PKP相近的临床疗效,因其不需使用昂贵的球囊,因而有着良好的临床推广应用前景。

Objective To evaluate the treatment of osteoporotic vertebral compression fractures(OVCF) by using high viscosity bone cement combined with hyperextension body position.Methods In thisretrospective study,159 patients were divided into PVP group,PKP group and high viscosity bone cement group(using high viscosity bone cement combined with hyperextensionbody position).The visual analogue scale(VAS) score,vertebral Cobb angle,vertebral height restoration recovery rate,and bone cement leakage rate wereobserved and compared to determine the effect of each group retrospectively.Results The bone cementleakage rate in PVP group,PKP group and high viscosity bone cement group was 14.3%,5.9%,and 5.8%respectively,which was significantly higher in PVP group than in the rest two groups(χ~2=30.792,P=0.021;χ~2=37.831,P=0.016).The vertebral height recovery rate in PVP group,PKP group and high viscosity bone cementgroup was(36.0±2.9)%,(75.0±3.3)% and(79.0±3.6)% respectively,which was significantly lower in PVP groupthan in the rest two groups(t=3.886,P=0.012;t=3.996,P=0.008).The changes of Cobb angle in PKP group andhigh viscosity bone cement group were significant after operation.The postoperative VAS scores in the threegroups were statistically significantly lower than those before(P<0.05 for all).Conclusion Postural reductioncombined with high viscosity bone cement in the treatment of vertebral compression fractures,could achieve thesame clinical efficacy with PKP,and didn t need the expensive balloons,therefore had a good promotionprospects.