骨质疏松性中胸椎压缩骨折的临床特点及PVP手术疗效分析

Clinical features of osteoporotic vertebral compression fractures of middle thoracic vertebra and effect of percutaneous vertebroplasty

目的总结骨质疏松性中胸椎压缩骨折的临床特点,并评估采用经皮椎体成形术(PVP)治疗后的临床效果。方法回顾性分析自2013-12—2017-03诊治的46例骨质疏松性中胸椎压缩骨折,均采用单侧穿刺PVP治疗。从病史、临床表现、基础疾病、骨质疏松程度、影像学方面分析其临床特点,比较术前、术后3 d、术后1个月胸背痛VAS评分、JOA日常活动受限度评分(ADL)、骨折椎体中间高度比值及骨折椎体Cobb角。结果骨质疏松性中胸椎压缩骨折的临床表现为胸痛、背痛及起卧困难等,部分患者平卧、翻身困难,骨质疏松严重,多合并下胸椎及腰椎陈旧性骨折。术前、术后3 d、术后1个月胸背痛VAS评分、ADL评分比较差异有统计学意义(P<0.05);且术后3 d、术后1个月胸背痛VAS评分、ADL评分较术前明显改善;术后1个月胸背痛VAS评分、ADL评分较术后3 d明显改善。术前、术后3 d、术后1个月骨折椎体中间高度、骨折椎体Cobb角比较差异无统计学意义(P>0.05)。结论 PVP治疗骨质疏松性中胸椎压缩骨折可以有效缓解患者胸背部疼痛,提高患者生活质量;但对于胸痛合并平卧功能受限的患者,术后常需进一步治疗。

Objective To analyze the clinical features of middle thoracic osteoporotic vertebral compression fractures （OVCF） and evaluate the efficiency of percutaneous vertebroplasty （PVP） on them. Methods Forty-six cases of OVCFs in middle thoracic vertebra were retrospectively analyzed between December 2013 and March 2017, which were treated by PVP of unilateral puncture. Clinical features of the OVCFs were analyzed based on pathography, clinical manifestation and physical sign, underlying diseases, bone mineral density and imaging. The scores of visual analogue scale （VAS） of chest and back pain, activities of daily living （ADL）, the middle vertebral height ratio and Cobb angle of injured vertebra were compared preoperatively, 3 d and 1 month postoperatively. Results Clinical features of middle thoracic OVCFs were chest pain, back pain and difficulty of getting out of bed and laying down. Some had difficulty in lying on the back and turning over （excluding abnormal cardio-pulmonary function）. Most of them did not have the traumatic history, but they had low bone mineral density and multiple segments of old fractures in low thoracic and lumbar spine. There were significant differences in the scores of VAS and ADL before operation, 3 days and 1 month after operation （P 〈0.05）, and the indexes 3 days and 1 month after operation were obviously improved, compared with that before operation. Furthermore, the scores of VAS and ADL 1 month after the operation were better than that 3 day after the operation. But there were no statistic difference in the middle vertebral height ratio and Cobb angle before the operation, 3 days and 1 month after the operation （P 〉0.05）. Conclusion PVP is effective and safe to treat OVCF in middle thoracic vertebra. But for some cases with chest pain, especially in patients with difficulty in lying on the back, further treatments are needed.