手法复位PCVP与单侧PKP治疗骨质疏松性椎体压缩骨折的效果分析

Effect of Manual Reduction Combined with PCVP and Unilateral PKP in the Treatment of Osteoporotic Vertebral Compression Fracture

目的对比观察手法复位弯角经皮椎体成形术(percutaneous curved vertebroplasty,PCVP)与单侧经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)的临床效果。方法选取我院2019年1—12月收治的85例OVCF患者,根据治疗方法的不同分为两组。复合组40例采用手法复位PCVP治疗,常规组45例采用单侧PKP治疗。记录两组手术时间、术中透视次数、骨水泥用量、骨水泥渗漏率、治疗费用、骨水泥分布等级,术前术后后凸Cobb角、伤椎前缘高度(AVH)、疼痛视觉模拟评分法(visual analogue scale,VAS)评分、Oswestry功能障碍指数(oswestry disability index,ODI)评分。结果复合组手术时间短于常规组,术中透视次数、治疗费用少于常规组,差异均有统计学意义(P<0.05或P<0.01)。复合组骨水泥用量大于常规组,骨水泥分布等级优于常规组,差异均有统计学意义(P<0.05或P<0.01)。两组骨水泥渗漏率比较差异无统计学意义(P>0.05)。两组术后后凸Cobb角、AVH、VAS评分、ODI评分均较术前改善(P<0.01),但两组组间比较差异均无统计学意义(P>0.05)。结论手法复位PCVP治疗OVCF不仅可达到常规PKP复位伤椎、改善后凸畸形的效果,而且可减少术中透视次数、缩短手术时间和降低治疗费用,但在缓解疼痛、改善脊柱功能方面无明显优势。

Objective To compare and observe the clinical effect of manual reduction combined with percutaneous curved vertebroplasty(PCVP)and simple unilateral percutaneous kyphoplasty(PKP)in the treatment of osteoporotic vertebral compression fractures(OVCF).Methods A total of 85 OVCF patients admitted to our hospital from January to December 2019 were selected and divided into two groups according to different treatment methods.Forty patients in the combination group received manual reduction combined with PCVP,and 45 patients in the conventional group received unilateral PKP.The duration of operation,the number of intraoperative X-ray fluoroscopy,bone cement dosage,bone cement leakage rate,treatment cost,bone cement distribution,pre-and post-operative kyphosis Cobb angle,anterior vertebral height(AVH),pain visual analogue scale(VAS)score,Oswetry disability index(ODI)score were recorded in the two groups.Results The duration of operation the number of intraoperative X-ray fluoroscopy and the treatment cost of the combination group were shorter or less than those of the conventional group(P<0.05 or P<0.01).The bone cement dosage in the combination group was greater than that of the conventional group,and the bone cement distribution was better than that of the conventional group(P<0.05 or P<0.01).There was no significant difference in bone cement leakage rate between the two groups(P>0.05).The postoperative kyphotic Cobb angle,AVH,VAS score,and ODI score of the two groups were improved compared with those preoperatively(P<0.01),but there was no significant difference between the two groups(P>0.05).Conclusion Manual reduction combined with PCVP in the treatment of OVCF can not only achieve the effect of conventional PKP to reduce the fractured vertebrae and improve the kyphosis,but also reduce the number of intraoperative X-ray fluoroscopy,shorten the duration of operation and reduce the treatment cost.However,it has not obvious advantages in alleviating pain and improving spinal function.