胸腰段骨折椎体成形术与保守治疗疗效比较

Comparison of vertebroplasty and conservative treatment for thoracolumbar fracture

目的比较胸腰椎骨折后椎体成形术与保守治疗的疗效。方法回顾性分析2010年1月至2015年10月,于我院接受治疗的122例脊柱骨折患者,其中椎体成形组(74例)和保守治疗组(48例)。随访各阶段均行X线评估骨折恢复情况。以疼痛视觉模拟评分(visual analogue scale,VAS)评估患者腰背痛程度,以Oswestry功能障碍指数(oswestry disability index,ODI)评估患者腰椎功能。以SPSS 19.0进行数据录入及分析。结果两组患者年龄、性别、体质量指数(body mass index,BMI)、骨密度(bone mineral density,BMD)、高血压、糖尿病及随访时间等一般情况差异无统计学意义(P>0.05)。两组间损伤节段分布差异无统计学意义(P>0.05)。两组患者治疗后VAS(椎体成形组:治疗后1个月2.27±0.76,末次随访1.35±1.08;保守治疗组:治疗后1个月2.71±0.90,末次随访2.00±0.80)及ODI(椎体成形组:治疗后1个月13.41±3.41,末次随访6.49±2.23;保守治疗组:治疗后1个月26.17±5.27,末次随访13.04±2.12)评分均较治疗前(椎体成形组VAS 6.74±1.05,ODI 39.42±4.95;保守治疗组VAS 6.44±1.13,ODI 38.19±5.16)显著改善,差异有统计学意义(P<0.05)。两组间治疗前VAS及ODI评分差异无统计学意义(P>0.05),但在治疗后1个月及末次随访时椎体成形组VAS及ODI评分显著较保守治疗组低,差异有统计学意义(P<0.05)。椎体成形组返回正常生活或工作时间(3.61±0.45)周较保守治疗组(10.23±1.72)周短,差异有统计学意义(P<0.05)。椎体成形组末次随访时椎体前缘高度改善百分比(13.4±1.3)%显著高于保守治疗组(4.2±0.7)%,差异有统计学意义(P<0.05),且改善百分比与末次随访时VAS评分呈显著性负相关(r=-0.32,P<0.05)。椎体成形组邻近节段再骨折率(12.2%)显著高于保守治疗组(2.1%),差异有统计学意义(P<0.05),两组均无神经损伤、感染、压疮、深静脉血栓及死亡等严重并发症。结论椎体成形术能够有效恢复伤椎高度,维持胸腰段生理曲度,且较保守治疗能够有效迅速减缓胸腰段骨折后腰背痛,但其邻近节段再骨折率较保守治疗组高。

Objective To compare the effects of vertebroplasty and conservative treatment for thoracolumbar fracture. Methods We retrospectively reviewed 122 vertebral fracture cases from January 2010 to October 2015 in our department. Seventy-four cases were listed in the vertebroplasty group and 48 cases were in the conservative group. X-ray was utilized to access the recovery during the follow-up. Visual analogue scale（ VAS） was used to access the severity of the back pain and Oswestry disability index（ ODI） to access lumbar functions. Data analysis was done by SPSS 19.0. Results The two groups showed no differences in age, gender, body mass index（ BMI）, bone mineral density（ BMD）, high blood pressure, diabetes mellitus and follow-up time（ P〈0.05）. The 2 groups both got better VAS（ vertebroplasty group： 1 month follow-up 2.27 ± 0.76, final follow-up 1.35 ± 1.08; conservative group： 1 month follow-up 2.71 ± 0.90, final follow-up 2.00 ± 0.80） and ODI（ vertebroplasty group： 1 month follow-up 13.41 ± 3.41, final follow-up 6.49 ± 2.23; conservative group： 1 month follow-up 26.17 ± 5.27, final follow-up 13.04 ± 2.12）, which showed significant differences comparing to pre-treatment values（ vertebroplasty group VAS 6.74 ± 1.05, ODI 39.42 ± 4.95; conservative group VAS 6.44 ± 1.13, ODI 38.19 ± 5.16）（ P〈0.05）. Pre-treatment VAS and ODI showed no inner-group differences（ P〉0.05）. However, the vertebroplasty group showed lower VAS（ 2.27 ± 0.76, 1.35 ± 1.08） and ODI（ 13.41 ± 3.41, 6.49 ± 2.23） than the conservative group（ 2.71 ± 0.90, 2.00 ± 0.80; 26.17 ± 5.27, 13.04 ± 2.12） at 1 month and final follow-up（ P〈0.05）. The vertebroplasty patients could return to normal life earlier（ 3.61 ± 0.45） weeks than the conservative group（ 10.23 ± 1.72） weeks（ P〈0.05）. At the final follow-up, anterior vertebral restoration of the vertebroplasty group was better（ 13.4 ± 1.3） % than that of the conservative group（ 4.2 ± 0.7） %（ P〈0.05）. The improvement rate was negatively correlated with VAS score at the last follow-up（ r =-0.32, P〈0.05）. Adjacent fracture rate was higher in the vertebroplasty group（ 12.2%） than in the conservative group（ 2.1%）（ P〈0.05）. No complications of neurological injury, infection, bedsore, deep venous thrombosis or death occurred during the follow-up. Conclusions Vertebroplasty can effectively restore the height of the fractured vertebra, maintaining the curvature of the thoracolumbar spine. It can reduce back pain more effectively than the conservative treatment. However, adjacent vertebral fracture rate is higher in the vertebroplasty group.