经皮椎体成形术与经皮椎体后凸成形术治疗重度骨质疏松性椎体压缩骨折的疗效对比

Comparative analysis of percutaneous vertebroplasty and percutaneous kyphoplastyon for the elderly severe osteoporotic vertebral compression fractures

目的对比分析经皮椎体成形术(PVP)与经皮椎体后凸成形术(PKP)治疗重度骨质疏松性椎体压缩骨折(OVCF)的临床疗效及安全性。方法回顾性分析河北医科大学第三医院脊柱外科2012年9月至2015年9月行PVP或PKP治疗的重度OVCF 57例,根据手术方式不同分为PVP组(n=31)和PKP组(n=26)。随访并比较两组患者术前、术后1 d及末次随访时伤椎前缘高度、局部Cobb角、疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)的变化以及骨水泥渗漏、邻近椎体骨折等术后并发症发生情况。结果所有手术均顺利完成,57例患者均获完整随访,随访时间12~20个月,平均(16.1±2.3)个月。PVP组患者的手术时间为(30±3)min,少于PKP组的(37±4)min,差异有统计学意义(t=7.413,P<0.05)。两组患者术后1 d及末次随访时VAS、ODI评分及局部Cobb角较术前均有改善,差异有统计学意义(PVP组:F=260.639,F=276.357,F=20.783,P<0.01;PKP组:F=162.701,F=196.772,F=83.591,P<0.01)。PKP组患者术后1 d及末次随访时伤椎前缘高度较术前均有改善,差异有统计学意义(F=22.084,P<0.01),PVP组术后伤椎前缘高度与术前相比无统计学差异。两组间术后1 d及末次随访时VAS、ODI评分比较,无统计学差异。PKP组术后伤椎前缘高度及局部Cobb角改善均优于PVP组,差异有统计学意义(P<0.05)。术中发生骨水泥渗漏15例(26.3%),无肺栓塞、脊髓神经损伤发生。随访期间共5例(8.8%)患者继发邻近椎体骨折。两组骨水泥渗漏率及邻近椎体骨折发生率无统计学差异。结论对于重度骨质疏松性椎体压缩骨折的治疗,PVP与PKP均可显著缓解患者疼痛症状;PKP具有较好的复位和矫正后凸畸形的效果,但手术时间较长;PKP在骨水泥渗漏率、邻近椎体骨折发生率上相对于PVP未表现出明显的优越性。

Objective To compare the clinical efficacy and safety of percutaneous vertebroplasty （PVP） and percutaneousky phoplasty （PKP） in the treatment of severe elderly osteoporotic vertebral compression fractures （OVCF）. Methods A retrospective study was performed in 57 elderly OVCF who underwent PKP and PVP from September 2012 to September 2015 at the Third Hospital of Hebei Medical University. Patients were divided into PVP group （n=31） and PKP group （n=26） according to treatment method. The anterior height of vertebrae fractured, local kyphotic angle, Visual analogue scale （VAS）, Oswestry disability index （ODI）, leak of bone cement and fracture of adjacent vertebra between two groups were observed and compared. Results All 57 cases received an average of 16.1±2.3 months follow-up （12- 20 months）. The operation time of PVP group （30±3 min） was shorter than PKP group （37±4 min）, with significant differences （t=7.413, P〈0.05）. Compared with preoperative data, the local kyphotic angle, VAS and ODI score were improved with significant differences at 1 d after operation and the last follow-up in two groups （PVP： F=260.639, F=276.357, F=20.783, P〈0.01; PKP： F=162.701, F=196.772, F=83.591, P〈0.01）. At 1 day after operation and the last follow-up, the anterior height of vertebrae fractured was significantly improved compared with preoperative in PKP group （F=22.084, P〈0.01）, and there was no statistical difference compared with preoperative in PVP group. Between PVP group and PKP group, there were no statistically significant differences in the VAS and ODI score assessed at 1 day after operation and the last follow-up. However, PKP was significantly better than PVP in the replacement efficacy and corrections of local kyphotic angle （P〈0.05）. The leak of bone cement occurred in 15 cases （26.3%）, without pulmonary embolism and spinal cord injury. A total of 5 patients （8.8%） had fractures of adjacent vertebra during the follow- up period. There were no significant differences between two groups in the leakage rate of bone cement and incidence of adjacent vertebra fracture. Conclusion Both PVP and PKP can significantly relieve the pain of elderly OVCF. The replacement efficacy and kyphotic angle corrections of PKP are comparatively better than that of PVP. However, the operation time of PKP is longer than that of PVP. And PKP is not superior to PVP in leakage rate of bone cement, incidence of adjacent vertebra fracture.