经皮椎体后凸成形术与保守治疗在110例胸腰段骨质疏松性椎体压缩骨折中的疗效比较

Comparison of the efficacy of percutaneous kyphoplasty and conservative treatment in 110 cases of osteoporotic thoracolumbar vertebral compression fractures

[背景]比较经皮椎体后凸成形术(PKP)和保守治疗2种方法治疗胸腰段骨质疏松性椎体压缩骨折的疗效.[病例报告]选择2012年12月-2017年12月间接受PKP和保守治疗且随访均满1年的110例胸腰段骨质疏松性椎体压缩骨折患者,分为PKP治疗组(62例)和保守治疗组(48例),比较两组伤后即刻、术后(伤后)1个月及术后(伤后)1年的VAS评分、运动功能及镇痛剂使用情况,通过胸腰椎侧位片测定两组患者相同时间点的伤椎椎体高度丢失程度并记录伤后绝对卧床时间.分析结果见,PKP治疗组PKP术后1个月及术后1年时在疼痛减轻及运动功能恢复方面明显优于保守治疗组(P<0.05),但在使用镇痛剂方面,PKP治疗组仅在术后1个月时优于保守治疗组(P<0.05),术后1年时两组间差异无统计学意义(P>0.05);PKP治疗组术后1个月及术后1年时伤椎椎体高度丢失方面较保守治疗组有明显优势(P<0.05);PKP治疗组住院天数明显少于保守治疗组(P<0.05).[讨论] PKP治疗胸腰段骨质疏松性椎体压缩骨折可明显缩短伤后绝对卧床时间,有效减少长期卧床所导致的相关并发症发生,在临床疗效和放射学方面均优于保守治疗.

BACKGROUND To compare the efficacy of percutaneous kyphoplasty(PKP) and conservative treatment for osteoporotic thoracolumbar vertebral compression fractures. CASE REPORTS 110 patients with osteoporotic thoracolumbar vertebral compression fractures who underwent PKP and conservative treatment from December 2012 to December 2017 were selected, and all of them were followed up for 1 year. They were divided into PKP treatment group(62 patients) and conservative treatment group(48 patients). The VAS score, motor function and use of analgesics were compared between the two groups immediately after injury, 1 month after surgery(after injury) and 1 year after surgery(after injury). The degree of vertebral body height loss at the same time point was measured from thoracolumbar lateral radiographs, and the absolute bed time after the injury was recorded in the two groups. The analysis results showed that the PKP treatment group was significantly better than the conservative treatment group in pain relief and motor function recovery at 1 month and 1 year after surgery(P<0.05). However, in terms of the use of analgesics, the PKP treatment group was superior to the conservative treatment group only 1 month after surgery(P<0.05), and there was no statistical difference between the two groups at 1 year after surgery(P>0.05). The PKP treatment group had significant advantages over the conservative treatment group in vertebral body height loss 1 month and 1 year after surgery(P<0.05). The length of hospital stay in PKP treatment group was significantly lower than that in the conservative treatment group(P<0.05). DISCUSSION PKP treatment for osteoporotic thoracolumbar vertebral compression fractures could significantly shorten the absolute bed rest time after injury and effectively reduce the occurrence of related complications caused by long-term bed rest, which was better than conservative treatment in clinical efficacy and radiology.