经皮椎体成形术与椎体后凸成形术在老年骨质疏松椎体压缩性骨折中的效果比较

Comparison on the Clinical Efficacy of Percutaneous Vertebroplasty and Percutaneous Kyphoplasty in the Treatment of Elderly Patients with Osteoporotic Vertebral Compression Fracture

目的对比分析经皮椎体成形术(PVP)与经皮椎体后凸成形术(PKP)在老年骨质疏松椎体压缩性骨折(OVCF)治疗中的临床应用价值。方法根据手术方式不同,将93例老年OVCF患者分为PVP组50例和PKP组43例,比较两组手术时间、住院费用、骨水泥注入量及渗漏情况,观察手术前后患者疼痛、关节功能及伤椎椎体前缘高度和局部后凸角的变化。结果与PVP组比较,PKP组手术时间、骨水泥注入量及住院费用明显增加(P<0.05或P<0.01),但骨水泥渗漏发生率明显降低(P<0.05)。两组术后3 d及6个月的视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评分较术前明显下降(P<0.01),其中PKP组ODI评分下降程度更显著(P<0.05),但术后VAS评分组间无显著差异(P>0.05)。术后3 d及6个月,两组伤椎椎体前缘高度明显增加,局部后凸角明显减小(P<0.01),但PKP组增加、减小幅度均显著大于PVP组(P<0.05)。结论 PVP和PKP均可有效缓解老年OVCF患者疼痛,在椎体高度恢复和脊椎后凸角矫正方面PKP效果更优,且骨水泥渗漏情况较少。

OBJECTIVE To compare the clinical application values of percutaneous vertebroplasty（PVP） and percutaneous kyphoplasty（PKP） in the treatment of elderly patients with osteoporotic vertebral compression fracture（OVCF）. METHODS Totally 93 elderly pa-tients with OVCF were assigned into PVP group（n=50） and PKP group（n=43） based on different operation methods. The operationtime, hospital cost, injection volume and leakage of bone cement were compared between two groups, and the changes of pain, jointfunction, anterior height of injured vertebrae and local kyphotic angle were all observed. RESULTS Compared with PVP group, the op-eration time, injection volume of bone cement and hospital cost were increased（P〈0.05 or P〈0.01）, but the incidence of bone ce-ment leakage was decreased significantly in PKP group（P〈0.05）. Three days and 6 months after operation, both visual analoguescale（VAS） and oswestry disability index（ODI） scores were reduced markedly in two groups when compared with pre-operation（P〈0.01）, in which the reduced degree of ODI scores was more significant in PKP group（P〈0.05）, but there was no statistical signifi-cance between two groups with regard to the postoperative VAS scores（P〉0.05）. Three days and 6 months after operation, the anteri-or height of injured vertebrae was increased, while the local kyphotic angle was decreased obviously in two groups（P〈0.01）, but theincreased and decreased degrees in PKP group were higher than those in PVP group（P〈0.05）. CONCLUSION Both PVP and PKPcould alleviate the pain of elderly patients with OVCF, but PKP was superior to PVP in recovery of vertebral height, correction of spi-nal kyphosis and leakage of bone cement.