椎小关节注射与经皮椎体后凸成形治疗椎体轻度脆性骨折：快速镇痛与恢复脊柱稳定性

Facet joint injection versus percutaneous kyphoplasty for mild vertebral fragility fractures: rapid analgesia and restoration of spinal stability

背景:经皮椎体后凸成形治疗骨质疏松压缩性骨折受到临床上广泛的认可,但因存在骨水泥渗漏、邻近椎体再骨折等并发症促使临床医生寻求新的治疗方案。目的:对比研究椎小关节注射与经皮椎体后凸成形对轻度椎体脆性骨折的疗效。方法:纳入轻度椎体脆性骨折(骨质疏松性骨折)患者46例,根据治疗方案分为小关节注射组和经皮椎体后凸成形组。2组患者在给予规范的抗骨质疏松治疗基础上,分别行小关节注射和经皮椎体后凸成形治疗,记录2组患者治疗前,治疗后1周及第1,3,6,12个月时的数据,采用目测类比评分、功能障碍指数问卷表(Oswestry disability index,ODI)评估镇痛效果;采用椎体前缘高度、后凸角度、腰椎骨密度评估脊柱稳定性;比较再骨折发生率。研究方案的实施符合山西医学科学院山西大医院的相关伦理要求,所有患者均签署了“知情同意书”。结果与结论:①组内比较:与治疗前相比,2组患者治疗后各时间段的目测类比评分和ODI评分均显著降低(P<0.01),在12个月时椎体骨密度显著升高(P<0.05);经皮椎体后凸成形组的椎体前缘高度、后凸角度均优于治疗前(P<0.01);②组间比较:治疗后1周和1个月时,小关节注射组的目测类比评分和ODI评分显著高于经皮椎体后凸成形组(P<0.05),而在第3,6,12个月时2组的评分无明显差异(P>0.05);经皮椎体后凸成形组治疗后各时间点的椎体前缘高度、后凸角度均优于小关节注射组(P<0.01);③再骨折发生率2组差异无显著性(P>0.05);④结果说明,经过规范的抗骨质疏松治疗后,小关节注射和经皮椎体后凸成形都能为轻度椎体脆性骨折患者提供有效的镇痛,后者在快速镇痛和恢复脊柱稳定性方面有一定优势。

BACKGROUND:Percutaneous kyphoplasty(PKP)for the treatment of osteoporotic compression fractures has been widely recognized in clinical practice,but clinicians are still impelled to seek for new treatment regimens due to complications such as bone cement leakage and adjacent vertebral re-fracture.OBJECTIVE:To compare the therapeutic efficacy of facet joint injection(FJI)and PKP in the treatment of mild vertebral fragility fractures.METHODS:Forty-six patients with mild vertebral fragility fractures(osteoporotic fractures)were divided into FJI group and PKP group according to the treatment regimens.The two groups of patients were treated with FJI and PKP separately based on standardized anti-osteoporosis treatment.The data of each group were recorded before and 1 week,1,3,6,and 12 months after treatment.The analgesic efficacy was evaluated by visual analogue scale(VAS)and Oswestry disability index(ODI).Spine stability was evaluated by anterior vertebral height,kyphotic angle and lumbar spine density and the incidence of re-fracture were compared.The study protocol was implemented in line with the ethic requirements of Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences in China.Informed consent was obtained from each patient.RESULTS AND CONCLUSION:Intragroup comparison:VAS and ODI scores of patients in both groups were significantly decreased in each period after treatment compared with the baseline(P<0.05),and vertebral bone density was significantly increased at the 12th month after treatment(P<0.05).The anterior vertebral height and kyphosis angle of the PKP group were better than the baseline(P<0.05).Intergroup comparison:At the 1st week and 1st month after treatment,the VAS and ODI scores of the FJI group were significantly higher than those of the PKP group(P<0.05),while at the 3rd,6th,and 12th month,there was no significant difference between the two groups(P>0.05).After treatment,the anterior vertebral body height and kyphosis angle in the PKP group were better than those in the FJI group(P<0.05),and there was no significant difference in the incidence of re-fracture(P>0.05).Standardized anti-osteoporosis treatment with either FJI or PKP can provide effective analgesia for patients with mild vertebral fragility fracture,and PKP has certain advantages in rapid analgesia and recovery of spinal stability.