手法复位椎体成形术治疗老年严重椎体骨折的临床疗效及安全性分析

Clinical effectiveness and safety of manipulative reduction combined with vertebroplasty in treatment of severe vertebral fractures in elderly people

目的研究手法复位结合经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗老年严重椎体压缩骨折的临床疗效及安全性。方法选取2011年7月-2013年7月我院收治的严重椎体压缩骨折患者214例(共282个椎体),按治疗方式分为观察组和对照组,每组107例。对照组单纯行PVP手术治疗,观察组先行手法复位,后按对照组手术方式治疗,自术后1个月起定期随访,至2017年10月随访结束。比较两组的治疗总有效率,同时观察两组术后骨水泥渗漏情况、邻近椎体骨折率以及术后不同时间点的椎体骨折再发率。结果观察组术后总有效率91.59%,显著高于对照组(79.44%)(P=0.012)。观察组骨水泥渗漏总发生率为7.48%,显著低于对照组(23.36%)(P=0.001);观察组的邻近椎体骨折发生率为1.87%,低于对照组的8.41%(P=0.030)。两组术后1个月、3个月时椎体压缩骨折的再次发生率差异无统计学意义(P>0.05);6个月后两组患者的骨折发生率逐渐增加,且对照组的骨折发生率高于观察组(P均<0.05)。结论手法复位联合椎体成形术治疗严重椎体骨折,降低了骨水泥渗漏发生率、邻近椎体骨折以及椎体压缩骨折再次发生率,可以作为治疗老年严重椎体骨折的一种有效手段在临床上推广应用。

Objective To study the clinical efficacy and safety of manipulative reduction combined with percutaneous vertebroplasty in the treatment of severe vertebral fractures in the elderly. Methods A total of 214 patients with severe vertebral fracture from July 2011 to July 2013 were selected and divided into observation group and control group with 107 cases in each group. The control group was treated with PVP surgery, and the observation group was treated with manual reduction plus surgical treatment. Regular follow-up was conducted one month after the operation and ended in October 2017. The total effective rate was compared between the two groups, and the postoperative leakage of bone cement, adjacent vertebral fracture rates, and vertebral fractures recurrence rate at different time points after surgery were observed. Results The total effective rate of observation group was significantly higher than that of control group （91.59% vs 79.44%, P=0.012）, while the total incidence of bone cement leakage and the incidence of adjacent vertebral fractures in observation group was significantly lower than that in control group （7.48% vs 23.36%, P=0.001; 1.87% vs 8.41%, P=0.030）. There was no significant difference in recurrence rate of vertebral compression fracture between the two groups at 1 and 3 months after surgery （P 〉 0.05）. After 6 months, the incidence of fractures in both groups increased gradually, and it was higher in the control group than that in the observation group （6.54% vs 18.69%, P=0.007）. Conclusion Manipulative reduction combined with percutaneous vertebroplasty decreases the incidence of leakage of bone cement, adjacent vertebral fracture rates and vertebral fractures recurrence rate in treatment of severe vertebral fractures in elderly people, which can be used as an effective and safe method for elderly people with severe vertebral fracture.