冰水辅助下经皮椎体成形术治疗老年骨质疏松性椎体压缩骨折

Percutaneous Vertebroplasty Assisted by Ice Water in the Treatment of Osteoporotic Vertebral Compression Fractures in the Elderly

目的:评估冰水辅助下经皮椎体成形术治疗老年骨质疏松性椎体压缩骨折的临床疗效及其安全性。方法:选取2016年7月—2018年12月117例老年骨质疏松性椎体压缩骨折患者按治疗方式不同分为三组,每组39例。X组给予冰水辅助下经皮注射骨水泥椎体成形术,Y组给予单纯经皮注射骨水泥椎体成形术,Z组严格卧床3个月+腰背肌锻炼+药物止痛+抗骨质疏松等保守治疗,比较三组的责任椎体高度变化情况、综合疗效、VAS评分及并发症发生情况。结果:(1)治疗前,三组患者伤椎前、后缘高度及后凸角无明显差异(P>0.05);治疗后3个月,伤椎前、后缘高度:X组>Y组>Z组(P<0.05),后凸角:X组<Y组<Z组(P<0.05)。(2)治疗后3个月综合疗效评价系统显示:X组总有效率为97.4%,Y组总有效率为87.2%,Z组总有效率为69.2%,三组之间差异有统计学意义(P<0.05)。(3)三组患者治疗前VAS评分无明显差异(P>0.05),治疗后3个月VAS评分:X组<Y组<Z组(P<0.05)。(4)并发症方面,治疗后3个月,X组肺炎0例(0%),脑梗死1例(2.6%);Y组肺炎2例(5.1%),脑梗死3例(7.7%);Z组肺炎13例(33.3%),脑梗死6例(15.4%),三组比较差异有统计学意义(P<0.05)。结论:冰水辅助下经皮椎体成形术在恢复伤椎高度、纠正后凸畸形、临床症状改善以及并发症安全性方面均优于单纯经皮椎体成形术及保守治疗。

Objective:To evaluate the clinical efficacy and safety of percutaneous vertebroplasty assisted by ice water in the treatment of elderly osteoporotic vertebral compression fractures.Methods:From July 2016 to December 2018,117 elderly patients with osteoporotic vertebral compression fractures were divided into three groups according to different treatment methods,39 cases in each group.Group X was treated with percutaneous injection of bone cement vertebroplasty assisted by ice water.Group Y was treated with percutaneous injection of bone cement vertebroplasty alone.Group Z was treated with conservative treatment such as strict bed rest for 3 months+lumbar and dorsal muscle exercise+drug analgesia+anti-osteoporosis.The height change,comprehensive effect,VAS score and complications of the three groups were compared.Results:(1)Before treatment,there was no significant difference in anterior and posterior margin height and kyphosis angle between the three groups(P>0.05);3 months after treatment,the anterior and posterior margin height of the injured vertebra:X group>Y group>Z group(P<0.05),kyphosis angle:X group<Y group<Z group(P<0.05).(2)3 months after treatment,the comprehensive efficacy evaluation system showed that the total effective rate was 97.4%in group X,87.2%in group Y and 69.2%in group Z.There was significant difference among the three groups(P<0.05).(3)There was no significant difference in VAS score among the three groups before treatment(P>0.05).Three months after treatment,VAS score was as follows:group X<group Y<group Z(P<0.05).(4)Complications:3 months after treatment,group X had pneumonia in 0 cases(0%)and cerebral infarction in 1 case(2.6%);group Y had pneumonia in 2 cases(5.1%)and cerebral infarction in 3 cases(7.7%);group Z had pneumonia in 13 cases(33.3%)and cerebral infarction in 6 cases(15.4%).There were significant differences among the three groups(P<0.05).Conclusion:Percutaneous vertebroplasty assisted by ice water is superior to percutaneous vertebroplasty and conservative treatment in restoring the height of injured vertebrae,correcting kyphosis,improving clinical symptoms and safety of complications.