弯角椎体成形术治疗骨质疏松性椎体压缩骨折疗效分析

Analysis of the curative effect of the treatment of osteoporotic vertebral compression fracture with angle vertebroplasty

目的观察弯角椎体成形术(PCVP)治疗骨质疏松性椎体压缩骨折(OVCF)的临床疗效。方法收集2018年12月-2019年6月延安大学附属医院骨科收治老年新鲜单节段脊柱胸腰段OVCF患者76例临床资料,依据术中是否采用PCVP分为弯角组36例和常规组40例。弯角组采用PCVP完成手术;常规组采用常规单侧经皮椎体成形术(PVP)完成手术。观察2组手术时间、术中透视次数、骨水泥注入量、骨水泥渗漏率、骨水泥双侧分布率,术前术后疼痛视觉模拟(VAS)评分、Oswestry功能障碍指数(ODI)评分及手术预后情况。结果 2组手术时间、术中透视次数比较,差异均无统计学意义(P>0.05)。弯角组骨水泥注入量、骨水泥双侧分布率大于常规组,而骨水泥渗漏率小于常规组,差异均有统计学意义(t/P=2.308/0.023,Z/P=3.638/0.000,χ~2/P=4.395/0.036)。2组术后VAS评分、ODI评分较术前均降低,差异有统计学意义(t/P=28.134/0.000、29.840/0.000,11.979/0.000、11.887/0.000);2组间比较,差异无统计学意义(P>0.05)。76例手术均顺利完成,术中未出现血管神经损伤等并发症。结论与常规PVP比较,采用PCVP治疗新鲜单节段OVCF,在降低骨水泥渗漏风险的同时,有效地增加骨水泥注入量、改善骨水泥双侧分布情况;但在术后疼痛缓解和功能改善方面无明显优势。

Objective To observe the clinical effect of PC VP in the treatment of osteoporotic vertebral compression fracture(OVCF).Methods From December 2018 to June 2019,76 cases of elderly fresh single segment spine,thoracolumbar OVCF were collected from Orthopedic Department of Affiliated Hospital of Yanan University.According to whether PCVP was used during the operation,they were divided into 36 cases of bending angle group and 40 cases of conventional group.PCVP was used in the angle group and PVP was used in the conventional group.The time of operation,the times of intraoperative fluoroscopy,the amount of bone cement injection,the leakage rate of bone cement,the bilateral distribution rate of bone cement,the preoperative and postoperative pain visual analogue(VAS) scores,Oswestry dysfunction index(ODI) scores and the prognosis of the two groups were observed.Results There was no significant difference in the operation time and intraoperative fluoroscopy between the two groups(P>0.05).The amount of bone cement injected and the bilateral distribution rate of bone cement in the curved group were greater than those in the conventional group,while the leakage rate of bone cement was less than that in the conventional group.The differences were statistically significant(t/P=2.308/0.023,Z/P=3.638/0.023,χ~2/P=4.395/0.036).The VAS score and ODI score of the two groups were lower than before surgery,and the differences were statistically significant(t/P=28.134/0.000,29.840/0.000,11.979/0.000,11.887/0.000).There was no significant difference between the two groups(P>0.05).76 cases of surgery were successfully completed without complications such as vascular and nerve injury.Conclusion Compared with conventional PVP,PCVP can effectively increase the amount of bone cement injected and improve the bilateral distribution of bone cement while reducing the risk of leakage of bone cement.However,PCVP has no obvious advantage in postoperative pain relief and functional improvement.