单侧与双侧PVP治疗骨质疏松性胸腰椎新鲜压缩性骨折的临床疗效比较

Comparison of clinical efficacy between unilateral and bilateral PVP in the treatment of fresh osteoporotic vertebral compression fracture

目的 比较单侧与双侧经皮椎体成形术(PVP)治疗骨质疏松性胸腰椎新鲜压缩性骨折患者的临床疗效。方法 250例骨质疏松性胸腰椎新鲜压缩性骨折患者,通过随机抽签分组法分为对照组和观察组,每组125例。对照组采用单侧PVP进行治疗,观察组采用双侧PVP进行治疗。对比两组手术相关指标、视觉模拟评分法(VAS)评分、椎体改善情况[椎体高度、椎体后凸Cobb角、Oswestry功能障碍指数(ODI)]、临床疗效。结果 观察组手术时间(38.62±2.38)min长于对照组的(26.53±2.36)min,透视次数(16.83±2.46)次、骨水泥用量(4.63±0.35)ml均少于对照组的(20.48±3.50)次、(5.86±0.42)ml,骨水泥分布率(92.15±2.74)%高于对照组的(68.36±2.26)%,骨水泥渗漏率10.40%低于对照组的20.80%,差异具有统计学意义(P<0.05)。术前,两组VAS评分比较差异无统计学意义(t=0.823,P>0.05);术后1 d,观察组的VAS评分为(1.21±0.45)分,低于对照组的(2.16±0.45)分,差异具有统计学意义(t=16.690, P<0.05);术后1个月,观察组的VAS评分为(1.26±0.48)分,低于对照组的(2.10±0.58)分,差异具有统计学意义(t=12.474, P<0.05)。术前及术后1个月,两组患者的椎体高度、椎体后凸Cobb角、ODI对比,差异均无统计学意义(P>0.05)。术后随访6个月,观察组患者的有效率90.40%(113/125)高于对照组的80.00%(100/125),差异具有统计学意义(χ^(2)=5.361, P<0.05)。结论 双侧PVP治疗骨质疏松性胸腰椎新鲜压缩性骨折患者的骨水泥分布率高,且骨水泥渗漏率更低, VAS评分更低,因此长期疗效更为显著。

Objective To compare the clinical efficacy between unilateral and bilateral percutaneous vertebroplasty(PVP) in the treatment of fresh osteoporotic vertebral compression fracture. Methods A total of 250 patients with fresh osteoporotic vertebral compression fracture were randomly divided into control group and observation group, with 125 cases in each group. The control group was treated with unilateral PVP, and the observation group was treated with bilateral PVP. The surgery-related indicators, visual analogue scale(VAS) score, vertebral body improvement [vertebral body height, kyphotic Cobb angle, Oswestry disability index(ODI)], and clinical efficacy were compared between the two groups. Results In the observation group, the operation time(38.62±2.38) min was longer than(26.53±2.36) min in the control group;the frequency of fluoroscopy(16.83±2.46) times and the amount of bone cement(4.63±0.35) ml were all less than(20.48± 3.50) times and(5.86±0.42) ml in the control group;the bone cement distribution rate(92.15±2.74)% was higher than(68.36±2.26)% in the control group;the bone cement leakage rate 10.40% was lower than 20.80% in the control group;all the differences were statistically significant(P<0.05). Before surgery, there was no statistically significant difference in VAS scores between the two groups(t=0.823, P>0.05). 1 d after surgery, the VAS score of the observation group was(1.21±0.45) points, which was lower than(2.16±0.45) points of the control group, and the difference was statistically significant(t=16.690, P<0.05). 1 month after surgery, the VAS score of the observation group was(1.26±0.48) points, which was lower than(2.10±0.58) points of the control group, and the difference was statistically significant(t=12.474, P<0.05). There was no statistically significant difference in the vertebral height, kyphotic Cobb angle and ODI between the two groups before surgery and 1 month after surgery(P>0.05). After 6 months of follow-up, the effective rate 90.40%(113/125) of the observation group was higher than 80.00%(100/125) of the control group, and the difference was statistically significant(χ^(2)=5.361, P<0.05). Conclusion Bilateral PVP treatment for fresh osteoporotic vertebral compression fracture has higher bone cement distribution rate, lower bone cement leakage rate and lower VAS score, so the long-term efficacy is more significant.