经皮椎体后凸成形术治疗围绝经期椎体压缩骨折的疗效评价

Curative effect of percutaneous kyphoplasty for treatment of vertebral compression fractures in perimenopausal women

目的探讨经皮椎体后凸成形术（PKP）治疗围绝经期椎体压缩骨折的有效性。方法采用回顾性病例对照研究分析2007年1月-2014年3月收治的围绝经期椎体压缩骨折患者53例（70个椎体），其中单椎体压缩骨折36例，双椎体压缩骨折17例。伤椎分布：T11 5个、T12 14个，L1 30个，L2 12个，L3 9个。骨折压缩程度10％～30％。根据治疗方法分为PKP组和非手术组。PKP组30例，年龄44～54岁，平均51．0岁。伤椎分布：T11 3个，T12 11个，L1 17个，L2 7个，L3 3个。非手术治疗组23例，年龄44—54岁，平均50．5岁。伤椎分布：T11 2个，T12 3个，L1 13个，L2 5个，L3 6个。比较两组术前及治疗后2周、6个月和36个月视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）、椎体高度压缩率、Cobb角及骨密度变化。结果随访6～36个月。两组治疗后2周、6个月和36个月VAS及ODI均较术前明显改善（P〈0．01）；与非手术组比较，PKP组治疗后2周和6个月VAS和ODI指数明显降低（P〈0．01）。治疗后6个月与术前比较，非手术组Cobb角及压缩率较术前明显增加（P〈0．05）。治疗后36个月与6个月比较，非手术组椎体Cobb角及椎体压缩率继续加重不明显。与术前比较，PKP组治疗后6个月椎体Cobb角及压缩率减小（P〈0．05），治疗后36个月椎体Cobb角及压缩率有增加，但差异无统计学意义（P〉0．05）。治疗后6个月和36个月时PKP组Cobb角及椎体压缩率与非手术组差异有统计学意义（P〈0．05）。与治疗前比较，治疗后6个月及36个月非手术组骨密度有不同程度降低（P〈0．05），而PKP组降低差异无统计学意义（P〉0．05）。与非手术组比较，治疗后36个月PKP组骨密度降低更少（P〈0．01）。PKP组骨密度下降缓慢，与术前比差异无统计学意义（P〉0．05）。非手术组骨密度下降较快，治疗后36个月较术前显著下降（P〈0．05）。结论对围绝经期患者椎体压缩骨折行PKP能明显缓解近期和远期疼痛，降低后凸畸形程度，延缓骨含量的下降。

Objective To investigate the clinical outcomes of percutaneous kyphoplasty （PKP） for treatment of vertebral compression fractures in perimenpausal women. Methods A total of 53 perimenopausal patients （70 vertebrae） undergone PKP for vertebral compression fractures from January 2007 to May 2014 were analyzed retrospectively by case-control study. Thirty-six patients had single vertebral fractures and 17 two-level vertebral fractures. The fracture segments included 5 T11 vertebrae, 14 T12 vertebrae, 30 L1 vertebrae, 12 L2 vertebrae and 9 L3 vertebrae. Ratio of vertebral compression was 10%-30%. According to treatment difference, the patients were divided into PKP group and non-operation group. In PKP group, there were 30 patients with age range of 44-54 years （mean, 51.0 years）, and the fracture segments included 13 TH vertebrae, 11 T12 vertebrae, 17 L1 vertebrae, 7 L2 vertebrae,3 L3 vertebrae. In non-operation group, there were 23 patients with age range of 44-54 years （ mean, 50.5 years）, and the fracture segments included 2 T11 vertebrae, 3 T12 vertebrae, 13 L1 vertebrae, 5 L2 vertebrae,6 L3 vertebrae. Visual analogue scale （VAS）, Oswesty disability index （ODI）, vertebral compression rate, Cobb angle and bone mineral density change were compared preoperatively, 2 weeks, 6 months and 3 years after operation. Results All patients were followed up for 6-36 months. VAS and ODI were improved compared with preoperative status in two groups at 2 weeks, 6 months and 3 years （ P 〈 0.01 ）. VAS and ODI in PKP group were significantly decreased at 2 weeks and 6 months compared with non-operation group （ P 〈 0.01 ）. The Cobb angle and vertebral compression rate in non-operation group were improved at 6 months compared with those in preoperative status （ P 〈 0.05 ）, and a consistent increase was noted at 3 years, but the difference was not statistically significant （ P 〉 0.05 ）. The Cobb angle and vertebral compression rate in PKP group were reduced at 6 months compared with preoperative status （ P 〈 0.05 ）, and an increase was noted at 3 years, but the difference was not statistically significant （P 〉 0.05 ）. The Cobb angle and vertebral compression rate in PKP group did not increase at 6 months and 3 years, but they had significant increase in non-operation group （ P 〈 0.05 ）. The body mass index in non-operation group decreased at different degrees at 6 months and 3 years, compared with preoperative status （ P 〈 0.05 ）, while the body mass index reduction in PKP group had no statistically significant difference （ P 〉 0.05 ）. The body mass index reduction in PKP group was less than that in non- operation group at 3 years （P 〈 0.01 ）. The body mass index reduction in PKP group was slow and had no statistically significant difference compared with preoperative status （ P 〉 0.05 ）. The body mass index reduction in non-operation group was fast and had significant decrease compared with preoperative status （ P 〈 0.05 ）. Conclusion PKP can relieve pain for vertebral compression fractures in perimenopausal women in short term and long term, and PKP can also improve spinal kyphosis and prohibit the decline of bone mineral density.