经皮椎体后凸成形术治疗骨质疏松性椎体骨坏死疗效分析

Analysis of the Efficacy of Percutaneous Kyphoplasty( PKP) in the Treatment of Osteoporotic Vertebral Osteonecrosis

目的探讨经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)分次注射和温度梯度注射骨水泥对骨质疏松性椎体骨坏死的治疗效果。方法回顾性分析四川省简阳市人民医院2013年11月~2015年11月93例患者的临床资料。根据治疗方式将患者分成观察组和对照组,其中观察组行PKP,采用分次灌注温度梯度技术注射骨水泥,共48例;对照组给予保守治疗,共45例。通过视觉模拟量表(VAS)和Oswestry功能障碍指数(ODI)综合评估治疗效果。结果观察组术后CT影像可见骨水泥分布良好,仅1例患者后期出现骨水泥渗漏,5例患者术后仍然疼痛,2例患者出现其他椎体骨折。VAS及ODI治疗前分别为8.12%±1.25%和80.24%±8.36%,治疗后分别为1.68%±0.32%和24.55%±7.97%;对照组18例患者疼痛,6例患者治疗后出现其他椎体骨折,骨折VAS及ODI治疗前分别为8.46%±1.53%和81.46%±7.65%,治疗后分别为3.04%±0.64%和30.48%±7.56%,两组均较治疗前有所好转,且在VAS及ODI方面比较,差异有统计学意义(P<0.05)。结论PKP分次灌注及温度梯度注射骨水泥法治疗骨质疏松性椎体骨坏死效果显著,且比较安全,值得推广。

Objective To investigate the therapeutic effect of bone cement perfusion at different times and temperature gradients for the percutaneous kyphoplasty(PKP)in the treatment of osteoporotic vertebral osteonecrosis.Methods The clinical data of 93 patients with osteoporotic vertebral necrosis from the People′s Hospital of Jianyang City from November 2013 to November 2015 were retrospectively analyzed.Participants were divided into observation group or control group according to their treatment.48 cases in the observation group were treated with bone cement perfusion at different times and temperature gradients for the PKP,while 45 cases in the control group received conservative therapy.The effect of treatment was evaluated byvisual analogue scale(VAS)andoswestrydisability index(ODI).Results In the observation group,the CT results showed that the bone cement was well distributed.Bone cement leakage to the vertebral body only occurred in 1 patient.5 patientsstill felt pain and 2 patients had other vertebral fractures after operation.The VAS score and ODI before treatment were 8.12%±1.25%and 80.24%±8.36%,respectively,and the postoperative indexes were 1.68%±0.32%and 24.55%±7.97%,respectively.In control group,18 patients still felt pain and 6 patients had other vertebral fractures after treatment.The VAS score and ODI before treatment were 8.46%±1.53%and 81.46%±7.65%,respectively and corresponding indexes after treatment were 3.04%±0.64%and 30.48%±7.56%,respectively.Both groups were better than before,and there were significant differences between groups in VAS score and ODI(P<0.05).Conclusion Bone cement perfusion at different times and temperature gradients for the percutaneous kyphoplastyis safe and achieved obvious therapeutic result in the treatment of osteoporotic vertebral osteonecrosis patients,and it is worthy of being promoted.