骨密度与经皮椎体后凸成形术疗效的相关性研究

Correlation between bone mineral density and the effect of percutaneous kyphoplasty

目的比较不同骨密度胸腰椎压缩性骨折行经皮椎体后凸成形术(PKP)治疗的有效性和安全性。方法 2014年1月至2016年4月该院收治的113例因椎体压缩性骨折(VCF)行PKP手术治疗的患者,男51例,女62例,年龄57~90岁,中位年龄73.7岁。按不同骨密度分为3组:骨量减少组(A组:T值>-2.5SD);骨质疏松1组(B组:―2.5SD≥T值>―3.5SD)、骨质疏松2组(C组:T值≤―3.5SD)。对3组患者术后视觉模拟评分(VAS评分)、腰痛功能(ODI)评分、椎体高度恢复、cobb角改善及并发症进行比较,并评价治疗效果。结果患者手术均顺利完成,术后随访6~24个月,平均15.8个月。3组患者的手术时间、术中出血量比较,差异无统计学意义(P>0.05)。3组患者术后VAS评分较术前降低,ODI评分较术前升高,椎体高度较术前增高,cobb角较术前减小,差异均有统计学意义(P<0.05)。术后VAS评分A组为(2.9±0.8)分、B组为(3.2±0.9)分、C组为(2.9±0.8)分,术后ODI评分A组(35.8±3.5)分、B组(35.3±3.7)分、C组(36.6±4.2)分,组间比较差异均无统计学意义(P>0.05)。术后椎体高度增加,C组为(6.6±2.8)mm、A组为(4.1±2.8)mm,C组大于A组,差异有统计学意义(P<0.05);术后cobb角纠正,C组为(6.2±2.3)、A组为(4.4±1.8),C组大于A组,差异有统计学意义(P<0.05)。骨水泥渗漏A组2例,B组4例,C组7例,渗漏率10.2%。结论 PKP治疗不同骨密度胸腰椎压缩性骨折均取得良好临床疗效;骨密度值越低,椎体高度恢复及cobb角纠正更为明显,但低骨密度者易出现骨水泥渗漏。

Objective To compare the effect and safety of the percutaneous kyphoplasty（PKP）in treating thoracolumbar vertebral compression fractures with different bone density.Methods Retrospective analysis of 113 cases with vertebral compression fractures（VCF）and underwent PKP in our hospital from January 2014 to April 2016 were performed,There were 51 males and 62 females,aged 57-90 years old,average 73.7 years old.According to the different Bone Mineral Density were divided into 3 groups：bone loss group（group A：T〉-2.5SD）,osteoporosis group 1（group B：-2.5SD≥T〉-3.5SD）,osteoporosis group 2（group C：-3.5SD≥T）.The postoperative VAS score,ODI score,vertebral height restoration,Cobb angle,and complications were compared to evaluate the surgical outcome.Results All operations were performed successfully and followed up for 6-24 months,average 15.8 months.There was no significant difference in operation time and intra-operative blood loss between the three groups（P〉0.05）.The postoperative VAS score of the three groups was lower than pre-operation,the ODI score was higher,the height of vertebral body was higher,the Cobb angle was smaller,and the difference were statistically significant（P〈0.05）.Postoperative VAS score of group A（2.9±0.8）,group B（3.2±0.9）,group C（2.9±0.8）,postoperative ODI score of group A（35.8±3.5）,group B（35.3±3.7）,group C（36.6±4.2）,there were no significant difference between the three groups（P〉0.05）.Postoperative vertebral height increased of group C（6.6±2.8）,group A（4.1±2.8）,group C was higher than group A,the difference was statistically significant（P〈0.05）.Cobb angle correction of group C（6.2±2.3）,group A（4.4±1.8）,group C was larger than group A,the difference was statistically significant（P〈0.05）.There were thirteen patients with bone cement leakage,two cases in group A,four cases in group B,seven cases in group C,the leakage rate was 10.2%.Conclusion PKP is an effective treatment for thoracic and lumbar vertebral compression fractures of different bone mineral density.Bone mineral density is lower,vertebral height restoration and Cobb angle correction is more obvious,but low bone mineral density is prone to bone cement leakage.