骨填充网袋椎体成形术与经皮椎体后凸成形术治疗骨质疏松性椎体爆裂骨折的比较

Comparison of Vesselplasty and Percutaneous Kyphoplasty in the Treatment of Osteoporotic Vertebral Burst Fractures

目的探讨骨填充网袋椎体成形术与经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松性椎体爆裂骨折(osteoporotic vertebral burst fracture,OVBF)的疗效差异。方法回顾性分析我科2015年1月~2017年12月58例OVBF,骨填充网袋椎体成形术组22例,PKP组36例。比较2组手术时间、骨水泥灌注量、骨水泥渗漏率、疼痛视觉模拟评分(Visual Analogue Score,VAS)、Oswestry功能障碍指数(Oswestry Disability Index,ODI)、伤椎前缘高度、伤椎后凸Cobb角。结果骨填充网袋椎体成形术组手术时间和骨水泥注入量与PKP组比较无明显差异(P>0.05)。骨填充网袋椎体成形术组骨水泥渗漏2例(9.1%),明显少于PKP组骨水泥渗漏14例(38.9%)(χ^2=4.670,P=0.031),均无神经脊髓症。58例术后随访12~36个月,平均24.4月。2组间VAS评分、ODI比较差异无显著性(P>0.05),组间和时间无交互作用(P>0.05)。2组患者术后1 d、末次随访VAS评分、ODI均明显小于术前(P均=0.000),且末次随访时较术后1 d进一步降低(P均=0.000)。2组间伤椎前缘高度、伤椎后凸Cobb角差异无显著性(P>0.05),组间和时间无交互作用(P>0.05)。2组患者术后1 d、末次随访时伤椎前缘高度显著高于术前(P均=0.000),末次随访时较术后1 d无明显丢失(P=0.144)。2组患者术后1 d及末次随访时伤椎后凸Cobb角明显小于术前(P均=0.000),末次随访时较术后1 d无明显变化(P=0.288)。骨填充网袋椎体成形术组1例手术椎体再骨折,2例非手术椎体骨折,PKP组4例非手术椎骨折,2组比较差异无统计学意义(P>0.05)。结论骨填充网袋椎体成形术和PKP治疗OVBF均可缓解患者的临床症状,部分恢复伤椎高度,矫正伤体后凸畸形,但骨填充网袋椎体成形术能有效降低骨水泥渗漏。

Objective To compare the efficacy of vesselplasty and percutaneous kyphoplasty(PKP)in the treatment of osteoporotic vertebral burst fracture(OVBF).Methods A retrospective analysis was made on 58 patients with OVBF from January 2015 to December 2017.According to the treatment method,they were divided into two groups:vesselplasty group(n=22)and PKP group(n=36).The operation time,bone cement perfusion and bone cement leakage rate were compared between the two groups.The Visual Analog Score(VAS),the Oswestry Disability Index(ODI),the anterior edge height of injured vertebrae,and the Cobb angle of kyphosis of injured vertebrae were recorded 1 day after operation and at the last follow-up.Results There were no significant differences in operation time and bone cement injection between the vesselplasty group and PKP group(P>0.05).In the vesselplasty group,there were 2 cases of bone cement leakage(9.1%),while in the PKP group,14 cases(38.9%),all of which had no neuromyelopathy.The leakage rate of bone cement in the vesselplasty group was lower than that in the PKP group(χ^2=4.670,P=0.031).The patients were followed up for 12-36 months with an average of 24.4 months.There was no significant difference in VAS scores and ODI between the two groups(P>0.05).There was no interaction between the groups and time(P>0.05).The VAS scores and ODI of the two groups were significantly lower 1 day after operation and at the last follow-up than those before operation(all P=0.000),and the VAS scores and ODI at the last follow-up were further lower than those 1 day after operation(all P=0.000).There was no significant difference in the anterior edge height and the Cobb angle between the two groups(P>0.05).There was no interaction between the groups and time(P>0.05).The anterior edge height of injured vertebrae in the two groups was significantly higher 1 day after operation and at the last follow-up than those before operation(all P=0.000),and there was no significant loss at the last follow-up(P=0.144).The Cobb angle of injured kyphosis in the two groups at 1 day after operation and at the last follow-up was significantly lower than those before operation(all P=0.000),but there was no significant change at the last follow-up as compared with that at 1 day after operation(P=0.288).During the follow-up period,there were 1 case of re-fracture of vertebrae and 2 cases of non-operative fracture of vertebrae in the vesselplasty group,and 4 cases of nonoperative fracture of vertebrae in the PKP group.There was no significant difference between the two groups(P>0.05).Conclusions Both vesselplasty and PKP can relieve the clinical symptoms of the patients,partially restore the height of the injured vertebrae,and correct the kyphosis of the injured body in the treatment of OVBF.However,bone pouch vesselplasty can effectively reduce bone cement leakage.