经皮椎体成形和经皮椎体后凸成形治疗老年骨质疏松性椎体压缩性骨折的对比

Comparison Analysis of Percutaneous Vertebroplasty and Percutaneous Kyphoplasty for Elderly Osteoporotic Vertebral Compression Fracture

目的 探讨经皮椎体成形术(percutaneous vertebroplasty,PVP)和经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗老年骨质疏松性椎体压缩性骨折的临床疗效。方法 回顾性分析2017年4月~2019年4月因骨质疏松性椎体压缩骨折行手术治疗的老年患者113例资料,其中PVP 70例,PKP 43例。比较2组手术时间、骨水泥注入量、骨水泥渗漏情况,以及手术前后疼痛视觉模拟评分(Visual Analogue Scale,VAS)、腰椎Oswestry功能障碍指数(Oswestry Disability Index,ODI)、椎体高度恢复等。结果 PVP组手术时间、骨水泥注入量均少于PKP组[(34.4±9.7)min vs.(53.8±16.7)min,t=-6.951,P=0.000;(4.5±1.7)ml vs.(6.8±1.4)ml,t=-7.439,P=0.000]。骨水泥渗漏PVP组6例(8.6%),PKP组1例(2.3%)(χ^2=0.875,P=0.350)。2组均未发生肺栓塞及神经损伤。2组术后即刻VAS及ODI均较术前显著降低,椎体高度明显增加,PKP组较PVP组变化更明显(P<0.05)。结论 PVP和PKP均可以明显改善疼痛和生活质量,PVP操作简便,PKP渗漏率低,更利于恢复椎体前缘高度,改善症状更明显。

Objective To investigate the clinical efficacy of percutaneous vertebroplasty(PVP)and percutaneous kyphoplasty(PKP)in the treatment of osteoporotic vertebral compression fracture(OVCF)in the elderly people.Methods A retrospective analysis was made on 113 elderly patients diagnosed as OVCF in our hospital from April 2017 to April 2019 and treated with surgery.The patients were divided into PVP group or PKP group,including 70 cases in PVP group and 43 cases in PKP group.The operation time,bone cement injection volume,bone cement leakage,Visual Analogue Scale(VAS),Oswestry Disability Index(ODI)and vertebral body recovery height were compared between the two groups.Results The average operation time of the PVP group was(34.4±9.7)min,which was significantly fewer than that of the PKP group[(53.8±16.7)min,t=-6.951,P=0.000].The bone cement injection volume of the PVP group was(4.5±1.7)ml,which was significantly lower than that of the PKP group[(6.8±1.4)ml,t=-7.439,P=0.000].There were 6 cases(8.6%)of bone cement leakage in the PVP group and 1 case(2.3%)in the PKP group(χ^2=0.875,P=0.350).No pulmonary embolism or nerve injury occurred in both groups.The VAS and ODI scores in both groups after surgery were significantly lower than those before surgery,and the vertebral body height was significantly higher than that before surgery.These changes occurred in PKP group were more obvious than those in PVP group(P<0.05).Conclusion Both PVP and PKP can significantly improve pain and quality of life.The PVP is simple to operate,while the PKP has less bone cement leakage rate and is more conducive to restore the height of the anterior edge of the vertebral body,which can obtain a higher quality of life.