经皮椎体成形术治疗伴有椎体内裂隙样变的脊柱压缩骨折的疗效观察

Observation of clinical effects of percutaneous vertebroplasty in the treatment of vertebral compression fractures complicated with intravertebral clefts

目的 :探讨经皮椎体成形术(PVP)对存在椎体内裂隙样变的骨质疏松性脊柱压缩性骨折的疗效。方法 :对2013年1月至2016年5月间收治的176例脊柱压缩性骨折患者的临床资料进行回顾性分析,所有患者进行单侧PVP手术治疗,其中37例患者存在裂隙样变,7例符合排除标准被剔除,最终观察对象为30例。30例患者中男14例,女16例,年龄60~93(77.73±9.33)岁;骨密度-2.3^-4.1(-3.16±0.48)SD。对患者术前及术后1 d、3个月、1年的VAS和ODI评分进行分析,并观察术前、术后3 d、3个月的椎体压缩百分比,评价PVP对于椎体内存在裂隙样变的压缩骨折患者的疼痛、功能及椎体高度恢复及维持情况。结果:所有患者手术顺利,且获得1年以上随访。术后1 d、3个月、1年的VAS评分分别为2.93±0.83、2.07±0.58、1.57±0.68,均较术前的7.00±1.41明显缓解(P<0.01);术后1 d、3个月、1年的ODI评分分别为36.2±4.1、22.9±6.7、18.8±5.9,较术前的40.5±3.9有明显改善(P<0.01)。患者术后3 d、3个月的椎体高度百分比分别为(79.26±8.57)%、(77.68±8.96)%,较术前的(72.00±12.14)%也有显著改善(P<0.05)。结论 :对于存在椎体内裂隙样变的骨质疏松性压缩骨折患者,经皮椎体成形术能有效恢复椎体高度,并能明显改善患者的疼痛及功能状况。

Objective：To explore the clinical effects of percutaneous vertebroplasty（PVP）in the treatment of osteoporotic vertebral compression fractures complicated with intravertebral clefts. Methods：The clinical data of 176 patients with osteoporotic vertebral compression fractures underwent treatment from January 2013 to May 2016 were retrospectively analyzed. All the patients were treated by unilateral PVP procedure,37 patients with intravertebral clefts. Seven cases were excluded according to the standard and 30 patients were internalized in the study. There were 14 males and 16 females,aged from 60 to 93 years old with an average of（77.73±9.33） years. The mean bone mineral density was（-3.16±0.48） SD（ranged from-2.3 to-4.1 SD）. The Oswestry Disability Index（ODI）,visual analogue scale（VAS） were analyzed before operation and 1 day,3 months,1 year after operation. The compression ratio of injured vertebrae was measured by X ray before operation and 3 days,3 months after operation. Results：All the operations were successful and all the patients were followed up more than 1 year.Postoperative at 1 d,3 months,1 year,VAS scores were obviously released（2.93±0.83,2.07±0.58,1.57±0.68,respectively）than preoperative 7.00±1.41（P〈0.01）;and ODI scores were obviously improved（36.2±4.1,22.9±6.7,18.8±5.9,respectively）than preoperative 40.5 ±3.9（P〈0.01）. Postoperative at 3 days,3 months,vertebral height percent of injured vertebrae were（79.26±8.57）%,（77.68±8.96）%,respectively,which had obviously improvement compared to preoperative（72.00±12.14）%（P〈0.05）. Conclusion：PVP is an effective and reliable method in the treatment of osteoporotic vertebral compression fractures complicated with intravertebral clefts. It can effectively restore the height of the vertebral body,obviously improve the patient＇s pain and functional status.