经皮椎体成形术治疗胸腰椎骨质疏松性椎体压缩性骨折后凸畸形

Percutaneous vertebroplasty for treatment of thoracolumbar osteoporotic vertebral compression fracture with kyphosis

目的探讨经皮椎体成形术(PVP)治疗伴有后凸畸形的胸腰椎骨质疏松性椎体压缩性骨折(OVCF)的临床疗效,并与经皮椎体后凸成形术(PKP)比较其对后凸畸形的矫正作用。方法回顾性分析2018年7月—2020年7月上海交通大学医学院附属新华医院采用PVP治疗的100例OVCF患者及采用PKP治疗的90例OVCF患者临床资料。比较2组患者术前及术后即刻、3个月、6个月和12个月疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)、伤椎Cobb角和伤椎前缘高度的变化。结果所有患者顺利完成手术并获得12~36(24.0±6.8)个月随访。PVP组手术时间显著少于PKP组,差异有统计学意义(P<0.05)。与术前相比,2组患者术后各随访时间点VAS评分、ODI、伤椎Cobb角和伤椎前缘高度均有所改善,差异有统计学意义(P<0.05)。PKP组术后即刻伤椎Cobb角和伤椎前缘高度明显优于PVP组,差异均有统计学意义(P<0.05),但在其余各随访时间点,2组间差异无统计学意义(P>0.05)。所有患者均未出现骨水泥渗漏入椎管、神经损伤、骨水泥肺栓塞、骨折椎体再塌陷等并发症。结论PVP治疗伴后凸畸形的OVCF,能够有效缓解疼痛,同时一定程度上恢复椎体高度、改善脊柱后凸畸形,临床效果与PKP相似,但手术时间明显短于PKP组。

Objective To investigate the clinical efficacy of percutaneous vertebroplasty(PVP)in the treatment of thoracolumbar osteoporotic vertebral compression fracture(OVCF)with kyphosis,and compare its corrective effect on kyphosis with percutaneous kyphosis(PKP).Methods The clinical data of 100 OVCF patients treated with PVP and 90 OVCF patients treated with PKP in Xinhua Hospital of Shanghai Jiao Tong University School of Medicine from July 2018 to July 2020 were retrospectively analyzed.The changes of pain visual analogue scale(VAS)score,Oswestry disability index(ODI),Cobb angle and anterior height of injured vertebrae were compared between the 2 groups before operation and immediately,3 months,6 months and 12 months after operation.Results All the patients successfully received the operation and were followed up for 12-36(24.0±6.8)months.The operation time in PVP group was significantly shorter than that in PKP group,with a statistical significance(P<0.05).Compared with pre-operation,VAS score,ODI,Cobb angle and anterior height of injured vertebra in the 2 groups were improved at each follow-up time point after operation,all with a statistical significance(P<0.05).The Cobb angle and anterior height of injured vertebrae immediately after operation in PKP group were significantly better than those in PVP group,and the differences were statistically significant(P<0.05);but there was no significant difference between the 2 groups at other follow-up time points(P>0.05).All the patients had no complications such as bone cement leakage into the spinal canal,nerve injury,bone cement pulmonary embolism and re-collapse of fractured vertebral body.ConclusionsPVP for treatment of OVCF with kyphosis can effectively relieve pain,partly restore vertebral height and improve kyphosis to a certain extent.The clinical effect of PVP is similar to PKP,but the operation time is significantly shorter than PKP.