经皮椎体后凸成形术对老年骨质疏松性椎体压缩骨折患者新发椎体骨折风险和生活质量的影响

Effect of Percutaneous Kyphoplasty on the Risk of New Vertebral Fractures and Quality of Life in Elderly Patients with Osteoporotic Vertebral Compression Fractures

目的:探讨经皮椎体后凸成形术(PKP)治疗老年骨质疏松性椎体压缩骨折的疗效及对患者新发椎体骨折风险和生活质量的影响。方法:选取2015年2月~2017年7月期间海南医学院第二附属医院收治的老年骨质疏松性椎体压缩骨折患者109例为研究对象,根据患者意愿和经济条件将其分为保守治疗组(n=54,采用非手术治疗)和PKP组(n=55,采用PKP治疗),比较两组患者临床指标、疼痛程度、椎体指标、生活质量、新发椎体骨折风险以及并发症发生情况。结果:PKP组住院时间、卧床时间低于保守治疗组(P<0.05)。两组患者治疗1周后、治疗1个月后、治疗3个月后、治疗6个月后以及治疗12个月后视觉疼痛模拟评分(VAS)逐渐降低(P<0.05),PKP组治疗1周后、治疗1个月后VAS评分低于保守治疗组(P<0.05)。保守治疗组治疗12个月后椎体前缘高度丢失率、Cobb角均低于治疗前及治疗1周后(P<0.05),PKP组治疗1周后、治疗12个月后椎体前缘高度丢失率、Cobb角逐渐降低(P<0.05);PKP组治疗1周后、治疗12个月后椎体前缘高度丢失率、Cobb角低于保守治疗组(P<0.05)。两组患者治疗12个月后标准生理组分(PCS)、标准心理组分(MCS)评分均较治疗前升高,且PKP组PCS、MCS评分高于保守治疗组(P<0.05)。两组患者新发椎体骨折发生率比较差异无统计学意义(P>0.05)。PKP组并发症发生率低于保守治疗组(P<0.05)。结论:PKP治疗老年骨质疏松性椎体压缩骨折疗效确切,安全可靠,可缩短患者住院时间和卧床时间,缓解患者早期疼痛,改善患者生活质量和伤椎后凸畸形,且不会增加新发椎体骨折风险。

Objective: To investigate the efficacy of percutaneous kyphoplasty(PKP) in the treatment of osteoporotic vertebral compression fractures in the elderly and its impact on the risk of new vertebral fractures and quality of life. Methods: 109 elderly patients with osteoporotic vertebral compression fractures who were admitted to the Second Affiliated Hospital of Hainan Medical University from February 2015 to July 2017 were selected as the study subjects. They were divided into conservative treatment group(n=54,non-surgical treatment) and PKP group(n=55, PKP treatment) according to patients’ wishes and economic conditions. The clinical indicators, pain, vertebral condition, quality of life, risk of new vertebral fracture and complications were compared between the two groups. Results: The hospitalization time and bedridden time of PKP group were lower than those of conservative treatment group(P<0.05). The visual analogue pain scale(VAS) scores of the two groups decreased gradually at 1 week, 1 month, 3 months, 6 months and 12 months after treatment(P <0.05). The VAS score of the PKP group was lower than that of the conservative group at 1 week after treatment and 1 month after treatment(P<0.05). The loss rate of anterior vertebral height and Cobb angle in the conservative treatment group were lower than those before treatment and 1 week after treatment(P<0.05). The loss rate of anterior vertebral height and Cobb angle in PKP group decreased gradually at 1 week and 12 months after treatment(P<0.05). The loss rate of anterior vertebral height and Cobb angle in the PKP group were lower than those in the conservative group at 1 week after treatment and 12 months after treatment(P<0.05). The standard phyisical component summary(PCS) and mental component summary(MCS) scores of the two groups at 12 months after treatment were higher than those before treatment, and the PCS and MCS scores of PKP group were higher than those of conservative treatment group(P<0.05). There was no significant difference in the risk of new vertebral fracture between the two groups(P>0.05). The incidence of postoperative complications in PKP group was significantly lower than that in conservative treatment group(P<0.05). Conclusion: PKP is effective, safe and reliable in the treatment of osteoporotic vertebral compression fractures in the elderly. It can shorten the hospitalization time and bedridden time, alleviate early pain, improve the quality of life and kyphosis deformity of patients, and does not increase the risk of new vertebral fracture.