经皮椎体后凸成形术不同手术时机在OVCF中应用

Application of different timing of percutaneous kyphoplasty in OVCF

目的:探讨经皮椎体后凸成形术(PKP)不同手术时机对骨质疏松椎体压缩性骨折(OVCF)患者腰椎功能、疼痛程度影响及相关性。方法:选取我院收治的142例OVCF患者,按随机数字表法分为A组(n=48)、B组(n=47)、C组(n=47)。A组于伤后7 d内行PKP,B组于伤后7~14 d内行PKP,C组于伤后14 d以上行PKP。观察3组并发症、骨水泥注入量、骨水泥分布情况,对比手术前后免疫功能、采用Oswestry功能障碍指数(ODI)、Cobb角、视觉模拟评分法(VAS),分析手术时机与VAS、ODI评分相关性。结果:A组骨水泥分布情况优于B组、C组,骨水泥量大于B组、C组,且B组骨水泥量大于C组(P<0.05);术后1周A组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平高于B组、C组,且B组高于C组(P<0.05);术后1周、3个月、6个月A组VAS、ODI评分及Cobb角低于B组、C组,B组低于C组(P<0.05);B组骨水泥渗透率低于A组、C组(P<0.05);Spearman相关性分析显示,手术时机与术后6个月VAS、ODI评分呈正相关关系(P<0.05)。结论:伤后7 d内行PKP可减轻OVCF患者疼痛程度,改善腰椎功能,且手术时机与VAS、ODI评分呈正相关关系,但伤后7~14 d内行PKP骨水泥渗漏发生率低,应结合患者实际情况选择手术时机。

Objective:To investigate the effect of different timing of percutaneous kyphoplasty(PKP)on the lumbar spine function and pain level of patients with osteoporotic vertebral compression fracture(OVCF)and conduct the correlation study.Methods:One hundred and forty-two patients with OVCF were selected from our hospital and divided into groups A(n=48),B(n=47)and C(n=47)by a random number table.Group A underwent PKP within 7 d after injury,group B underwent PKP between 7 and 14 d after injury,and group C underwent PKP more than 14 d after injury.The complications,bone cement injection volume and bone cement distribution were observed in the three groups,and immune function was compared before and after surgery.The correlation between the timing of surgery and the VAS and ODI scores was analyzed using Oswestry disability index(ODI),Cobb angle,and visual analog scale(VAS).Results:The distribution of bone cement in group A was better than that in groups B and C,the amount of bone cement was greater than that in groups B and C,and the amount of bone cement in group B was greater than that in group C(P<0.05);the levels of CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)in group A were higher than those in groups B and C in 1st week after surgery,and they were higher in group B than those in group C(P<0.05);the VAS,ODI scores and the Cobb angle in group A were lower than those in groups B and C in 1st week,3rd and 6th month after surgery,and they were lower in group B than those in group C(P<0.05);the bone cement leakage rate was lower in group B than that in groups A and C(P<0.05);Spearman correlation analysis showed that the timing of surgery was positively correlated with VAS and ODI scores in 6th month postoperatively(P<0.05).Conclusion:PKP within 7 d after injury can reduce the pain level and improve the function of the lumbar spine for OVCF patients,and the timing of surgery is positively correlated with VAS and ODI scores,but the incidence of bone cement leakage from PKP within 7 to 14 d after injury is low,and the timing of surgery should be selected according to the actual situation of the patients.