平乐正骨手法结合弯角椎体成形术治疗骨质疏松性椎体压缩骨折的回顾性研究

Retrospective Study of Pingle Orthopedic Manipulation Combined with PCVP in Treating OVCFs

目的:通过比较平乐正骨手法联合弯角椎体成形术(PCVP)、单纯PCVP以及单侧椎体成形术(PVP)治疗骨质疏松性椎体压缩骨折(OVCFs)的临床疗效,探讨平乐正骨手法联合PCVP的优点。方法:将2018年1月至2019年6月采用椎体成形术治疗的64例OVCFs患者纳入本次回顾性队列研究,按手术方式分为手法联合PCVP组(21例)、单纯PCVP组(20例)及单侧PVP组(23例),采集各组患者的骨水泥注入量及其分布情况、骨水泥渗漏率以及术前与术后1d的VAS评分和椎体前缘高度等数据资料并进行统计学比较。结果:手法联合PCVP组手术时间(47.90±5.19)min,长于单纯PCVP(37.50±4.04)min及单侧PVP组(38.95±3.36)min,差异有统计学意义(F=36.885,P<0.01),其余两组之间未见明显差异(P>0.05)。骨水泥注入量及骨水泥理想分布比例比较,手法联合PCVP组((4.55±0.75)mL(19/21))与单纯PCVP组((4.36±0.75)mL(17/20))两组均高或优于单侧PVP组((3.60±0.29)mL(11/23)),差异有统计学意义((F=14.322,P<0.01),(F=11.291 P<0.01))。椎体前缘高度组内比较,各组术后((24.19±1.99)mm,(20.20±3.03)mm,(20.78±4.02)mm)较术前((18.09±2.52)mm,(19.10±3.12)mm,(19.04±4.22)mm)均有改善((t=10.719,P<0.01),(t=6.866,P<0.01),(t=8.654,P<0.01))。组间对比:术后手法联合PCVP组高于其余两组且差异有统计学意义(F=8.525,P<0.01)。VAS评分组内比较,术后1d各组评分((2.76±1.17),(2.55±1.05),(2.56±1.07))较术前((7.61±1.16),(7.45±1.14),(7.43±1.12))明显降低,差异有统计学意义((t=13.007,P<0.01),(t=13.535,P<0.01),(t=14.823,P<0.01)),术后1d各组组间比较差异无统计学意义(F=0.241,P>0.05)。结论:平乐正骨手法联合PCVP治疗OVCFs在优化骨水泥分布和促进椎体前缘高度恢复方面具有优势,具有较高的临床推广应用价值。

Objective:To compare the clinical effects of Pingle orthopedic manipulation combined with percutaneous cornering vertebroplasty(PCVP),PCVP and unilateral percutaneous vertebroplasty(PVP) for the treatment of osteoporotic vertebral compression fracture(OVCFs),and to explore the advantages of Pingle orthopedic manipulation combined with PCVP.Methods:64 patients with OVCFs treated with vertebroplasty from January 2018 to June 2019 were included in this retrospective cohort study.All patients were divided into manual combined PCVP group(21 cases),PCVP group(20 cases) and unilateral PVP group(23 cases).The amount and distribution of bone cement injection,bone cement leakage rate,VAS score and the height of anterior vertebral body were documented and compared.Results:The operation time of the combined PCVP group(47.90±5.19) min was longer than that of the simple PCVP(37.50±4.04) min and the unilateral PVP group(38.95±3.36) min.The difference was statistically significant(F=36.885,P<0.01).No obvious difference was found between single PCVP and unilateral PVP group(P>0.05).Bone cement injection volume and ideal distribution ratio of bone cement showed that manipulation combined with PCVP group((4.55±0.75) mL(19/21)) and simple PCVP group((4.36±0.75) mL(17/20)) were higher than the unilateral PVP group((3.60±0.29) mL(11/23)),and the difference was statistically significant((F=14.322,P<0.01),(F=11.291,P<0.01)).Comparison of the anterior edge height of the vertebral body,the postoperative((24.19±1.99) mm,(20.20±3.03) mm,(20.78±4.02)mm) compared with the preoperative((18.09±2.52) mm,(19.10±3.12) mm,(19.04±4.22)mm) were improved((t=10.719,P<0.01),(t=6.866,P<0.01),(t=8.654,P<0.01)).Postoperative manipulation combined with PCVP group is higher than the other two groups and they showed statistical significance difference(F=8.525,P<0.01);VAS in each group significantly dropped from((7.61±1.16),(7.45±1.14),(7.43±1.12)) to((2.76±1.17),(2.55±1.05),(2.56±1.07))((t=13.007,P<0.01)(t=13.535,P<0.01),(t=14.823,P<0.01)).There was no statistically significant difference among three groups(F=0.241,P>0.05).Conclusion:Pingle orthopedic manipulation combined with PCVP in treating OVCFs has advantages in optimizing the distribution of bone cement and promoting the recovery of the height of the anterior edge of the vertebral body.