椎体内裂隙对PKP手术疗效的影响探讨

Effect of intra vertebral fissure on PKP surgery

目的探讨伴有椎体内裂隙的骨质疏松性椎体压缩骨折,对PKP手术疗效是否有所影响。方法自2014-05-2016-05采用PKP手术治疗OVCF患者80例,其中29例伴有椎体内裂隙,作为裂隙组;另51例无椎体内裂隙者,作为无裂隙组。对两组患者的骨水泥分布情况、渗漏情况,以及术后伤椎矫正情况,VAS评分、ODI指数改善情况等进行对比。结果与无裂隙组PKP手术相比:(1)裂隙组的骨水泥用量偏多,且骨水泥分布以团块型为主(19/29),渗漏率并未升高,以椎体周围渗漏多见(10.4%);(2)术后3 d的伤椎矫正效果更佳、但远期矫正丢失度较多(均为P<0.05);(3)术后3 d的疼痛和功能障碍改善差于无裂隙组(P<0.05),而术后1年恢复仍较可观。结论存在椎体内裂隙的OVCF患者行PKP手术时,其骨水泥分布和渗漏类型有所不同,术后早期有一定的疼痛残留和伤椎矫正度丢失现象,但随着时间的推移,其总体疗效较好。

Objective To investigate the influence of osteoporotic vertebral compression fractures with vertebral fractures on the PKP operation.Methods From May 2014 to May 2016,80 patients with OVCF were treated with PKP,of which 29 cases were accompanied by intra vertebral fractures,and the other 51 cases without fractures were treated as non fractured group.The bone cement distribution,leakage,correction of the injured vertebra,VAS score and the improvement of ODI index in the two groups were compared.Results Compared with the PKP surgery of non fracture group:(1)the ammount of bone cement in fracture group was larger,and the distribution of bone cement was in bulk based(19/29),the leakage rate was not increased,but the leakage was mainly around the vertebral body(10.4%).(2)The vertebral correction effect at postoperative 3 d was better,but the long-term correction loss was more(P<0.05).(3)The improvement of pain and dysfunction at postoperative 3 d was worse than non fractured group(P<0.05),but after 1 year of recovery,the recovery effect was still considerable.Conclusion For OVCF patients with vertebral fractures underwent PKP surgery,the bone cement distribution and leakage has different types,the early postoperative pain and residual vertebral correction loss phenomenon are existed,but with the time passed,the overall curative effect is better.