手法复位联合经皮椎体成形术治疗骨质疏松性椎体压缩骨折的临床研究

A clinical study of manipulative reduction combined with percutaneous vertebroplasty for treatment of osteoporotic vertebral compression fractures

目的:探讨手法复位联合经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)的临床疗效和安全性。方法:回顾性分析80例OVCF患者的病例资料,根据采用的治疗方法分为3组,采用手法复位联合PVP治疗28例、采用手法复位联合经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗25例、采用单纯PKP治疗27例。比较3组患者的手术时间、术中透视次数、骨水泥分布情况、骨水泥渗漏情况、腰背部疼痛视觉模拟量表(visual analogue scale,VAS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)评分。结果:3组患者手术时间、术中透视次数、骨水泥分布情况比较,组间差异均有统计学意义(F=4.424,P=0.015;F=5.584,P=0.004;Z=13.759,P=0.001)。手法复位联合PVP组手术时间短于手法复位联合PKP组和单纯PKP组(P=0.008;P=0.019);手法复位联合PKP组和单纯PKP组手术时间的差异无统计学意义(P=0.724)。手法复位联合PVP组术中透视次数少于手法复位联合PKP组和单纯PKP组(P=0.001;P=0.019);手法复位联合PKP组和单纯PKP组术中透视次数的差异无统计学意义(P=0.348)。手法复位联合PKP组的骨水泥分布情况最优,手法复位联合PVP组次之,单纯PKP组最差(R1=33.94;R2=34.39;R3=52.92)。3组患者治疗前、治疗后1周的腰背部疼痛VAS评分比较,组间差异无统计学意义(F=0.186,P=0.830;F=0.988,P=0.376);3组患者治疗后1周的腰背部疼痛VAS评分均显著低于治疗前[(7.5±1.3)分,(2.0±0.5)分,t=20.894,P=0.000;(7.7±1.5)分,(2.0±0.7)分,t=16.613,P=0.000;(7.7±1.4)分,(2.2±0.6)分,t=18.762,P=0.000]。3组患者治疗前、治疗后1周的ODI评分比较,组间差异无统计学意义(F=0.375,P=0.688;F=0.728,P=0.485)。3组患者治疗后1周的ODI评分均显著低于治疗前[(40.2±7.5)分,(20.4±7.4)分,t=9.944,P=0.000;(41.5±7.3)分,(20.1±7.0)分,t=10.579,P=0.000;(41.8±7.0)分,(22.3±7.2)分,t=10.090,P=0.000]。手法复位联合PVP组2例骨水泥渗漏,手法复位联合PKP组1例骨水泥渗漏,单纯PKP组2例骨水泥渗漏,均在暂停注入后停止渗漏,调整注入位点后完成骨水泥注入;3组患者骨水泥渗漏率比较,组间差异无统计学意义(χ^2=0.316,P=0.854)。术中无刺破椎体、神经血管损伤、医源性骨折。结论:手法复位联合PVP治疗OVCF与手法复位联合PKP、单纯PKP治疗的短期临床疗效与安全性相当,但手法复位联合PVP治疗OVCF的手术时间短、术中透视次数少,且骨水泥分布好。

Objective:To explore the clinical curative effects and safety of manipulative reduction combined with percutaneous vertebroplasty(PVP)for treatment of osteoporotic vertebral compression fractures(OVCF).Methods:The medical records of 80 OVCF patients were analyzed retrospectively.The patients were divided into three groups according to the therapies they received.Twenty-eight patients were treated with manipulative reduction combined with PVP(group A),25 patients were treated with manipulative reduction combined with percutaneous kyphoplasty(PKP)(group B),while the others were treated with monotherapy of PKP(group C).The operative time,intraoperative X-ray exposure,bone cement distribution,bone cement leakage,low back pain visual analogue scale(VAS)scores and Oswestry disability index(ODI)scores were compared between the 3 groups.Results:There was statistical difference in operative time,intraoperative X-ray exposure and bone cement distribution between the 3 groups(F=4.424,P=0.015;F=5.584,P=0.004;Z=13.759,P=0.001).The operative time was shorter in group A compared to group B and group C(P=0.008;P=0.019),and there was no statistical difference between group B and group C(P=0.724).The intraoperative X-ray exposure was less in group A compared to group B and group C(P=0.001;P=0.019),and there was no statistical difference between group B and group C(P=0.348).The bone cement had optimal-toworst distribution in group B,A and C in turn(■=33.94;■=34.39;■=52.92).There was no statistical difference in low back pain VAS scores between the 3 groups before the treatment and at 1 week after the treatment(F=0.186,P=0.830;F=0.988,P=0.376).The low back pain VAS scores decreased significantly at 1 week after the treatment compared to pretreatment in the 3 groups(7.5+/-1.3 vs2.0+/-0.5 points,t=20.894,P=0.000;7.7+/-1.5 vs 2.0+/-0.7 points,t=16.613,P=0.000;7.7+/-1.4 vs 2.2+/-0.6 points,t=18.762,P=0.000).There was no statistical difference in ODI scores between the 3 groups before the treatment and at 1 week after the treatment(F=0.375,P=0.688;F=0.728,P=0.485).The ODI scores decreased significantly at 1 week after the treatment compared to pretreatment in the 3 groups(40.2+/-7.5 vs 20.4+/-7.4 points,t=9.944,P=0.000;41.5+/-7.3 vs 20.1+/-7.0 points,t=10.579,P=0.000;41.8+/-7.0 vs 22.3+/-7.2 points,t=10.090,P=0.000).The bone cement leakage was found in 2 patients in group A,1 patient in group B and 2 patients in group C.The leakage stopped after suspension of injection,and the bone cement injection was completed after adjusting the injection site.There was no statistical difference in the incidence rate of bone cement leakage between the 3 groups(χ~2=0.316,P=0.854).No vertebral puncture,neurovascular injury and iatrogenic fracture were found during the surgery.Conclusion:The combination therapy of manipulative reduction and PVP is similar to the combination therapy of manipulative reduction and PKP and monotherapy of PKP in short-term curative effects and safty in treatment of OVCF,while the former has the advantages of shorter operative time,less intraoperative X-ray exposure and better bone cement distribution compared to the latter two.