CPC强化治疗青壮年胸腰椎压缩性骨折的疗效

Efficacy of CPC intensive therapy on young adults with thoracolumbar vertebral compression fractures

目的评价磷酸钙骨水泥(CPC)强化治疗青壮年胸腰椎压缩性骨折的效果。方法选取我院收治的青壮年胸腰椎压缩性骨折患者进行前瞻性研究,根据患者意愿将其分为观察组(n=38,采用CPC强化治疗)和对照组(n=40,采用保守治疗)。比较2组患者治疗前及治疗后1周、1个月、3个月、6个月、12个月疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI),比较2组患者治疗前及治疗后1周、3个月、6个月、12个月伤椎中线高度、伤椎后凸角,比较2组患者住院时间、返岗时间及下肢静脉血栓形成、便秘、抑郁症等并发症发生情况。采用汉密尔顿抑郁量表(HAMD)评估2组患者治疗前及治疗后1个月抑郁程度。结果观察组住院时间、返岗时间均短于对照组,差异有统计学意义(P<0.05)。2组患者治疗后1周、1个月、3个月、6个月及12个月的VAS评分和ODI均较治疗前降低,差异有统计学意义(P<0.05);且观察组治疗后1周、1个月、3个月、6个月的VAS评分及ODI低于对照组,治疗后12个月ODI低于对照组,差异均有统计学意义(P<0.05)。2组患者治疗前及治疗后1周、3个月伤椎中线高度比较,差异均无统计学意义(P>0.05),而观察组治疗后6个月、12个月伤椎中线高度高于对照组(P<0.05);观察组治疗后12个月伤椎中线高度高于治疗前,对照组治疗后12个月伤椎中线高度低于治疗前,差异均有统计学意义(P<0.05)。2组患者治疗前、治疗后1周伤椎后凸角比较差异无统计学意义(P>0.05),而观察组治疗后3个月、6个月、12个月伤椎后凸角均小于对照组(P<0.05);观察组治疗后12个月伤椎后凸角小于治疗前,对照组治疗后12个月伤椎后凸角大于治疗前,差异均有统计学意义(P<0.05)。观察组下肢静脉血栓形成、便秘、抑郁症等并发症发生率均低于对照组,差异有统计学意义(P<0.05)。观察组治疗后1个月HAMD评分较对照组低(P<0.05);观察组治疗后1个月HAMD评分较治疗前降低(P<0.05),而对照组治疗后1个月HAMD评分较治疗前升高(P<0.05)。结论与保守治疗相比,CPC强化治疗青壮年胸腰椎压缩性骨折安全、有效,在缓解疼痛、改善功能以及避免椎体高度丢失和后凸畸形加重的同时,还能显著减少下肢静脉血栓形成、便秘、抑郁症等并发症的发生,从而缩短患者的住院时间和返岗时间。

Objective To evaluate the effect of calcium phosphate cement(CPC)intensive therapy on young adults with thoracolumbar vertebral compression fractures.Methods The young adults with thoracolumbar vertebral compression fractures treated in our hospital were selected for prospective study,and they were divided into the observation group(n=38,received CPC intensive therapy)and the control group(n=40,received conservative treatment)according to patients'selections.The visual analogue scale(VAS)score and Oswestry disability index(ODI)before treatment and 1 week,1 month,3 months,6 months and 12 months after treatment were compared in the two groups.The midline height of the injured vertebra and the kyphosis angle of the injured vertebra before treatment and 1 week,3 months,6 months,and 12 months after treatment were compared in the two groups.The hospitalization time,return time and occurrence of complications such as lower extremity vein thrombosis,constipation and depressive disorder were compared between the two groups.The Hamilton depression scale(HAMD)was used to evaluate the degree of depression before treatment and 1 month after treatment in the two groups.ResultsThe hospitalization time and return time of the observation group were both shorter than those of the control group,with statistically significant differences(P<0.05).The VAS score and ODI 1 week,1 month,3 months,6 months and 12 months after treatment in the two groups were all lower than those before treatment,with statistically significant differences(P<0.05);the VAS score and ODI of the observation group 1 week,1 month,3 months and 6 months after treatment were lower than those of the control group,and the ODI 12 months after treatment was lower than that of the control group,with statistically significant differences(P<0.05).There was no significant difference in the midline height of the injured vertebra before treatment and 1 week,3 months after treatment between the two groups(P>0.05),while the midline heights of the injured vertebra 6 months and 12 months after treatment in the observation group were higher than those in the control group(P<0.05);the midline height of the injured vertebra 12 months after treatment in the observation group was higher than that before treatment,and the midline height of the injured vertebra 12 months after treatment in the control group was lower than that before treatment,with statistically significant differences(P<0.05).There was no significant difference in the kyphosis angle of the injured vertebra before treatment and 1 week after treatment between the two groups(P>0.05),while the kyphosis angles of the injured vertebra in the observation group 3 months,6 months and 12 months after treatment were smaller than those in the control group(P<0.05);the kyphosis angle of the injured vertebra 12 months after treatment in the observation group was smaller than that before treatment,and kyphosis angle of the injured vertebra 12 months after treatment in the control group was greater than that before treatment,with statistically significant differences(P<0.05).The incidences of complications such as lower extremity vein thrombosis,constipation and depressive disorder in the observation group were lower than those in the control group,with statistically significant differences(P<0.05).The HAMD score 1 month after treatment in the observation group was lower than that in the control group(P<0.05);the HAMD score of the observation group 1 month after treatment was lower than that before treatment(P<0.05),while the HAMD score 1 month after treatment of the control group was higher than that before treatment(P<0.05).Conclusion Compared with the conservative treatment,CPC intensive therapy is safe and effective for young adults with thoracolumbar vertebral compression fractures.It not only can relieve pain,improve function and avoid the loss of vertebral height and aggravation of kyphosis,but also can significantly reduce the occurrence of complications such as lower extremity vein thrombosis,constipation and depressive disorder,thereby shortening the hospitalization time and return time of patients.