经皮椎体-间盘成形术治疗胸腰段严重压缩的骨质疏松性椎体骨折的疗效分析

Percutaneous vertebral-disc plasty for very severe osteoporotic vertebral compression fractures

目的探讨经皮椎体-间盘成形术(PVDP)治疗胸腰段严重压缩的骨质疏松性椎体骨折(vsOVCF)的疗效。方法回顾性分析2019年11月至2021年8月南通大学第二附属医院脊柱外科采用PVDP治疗的26例胸腰段vsOVCF患者资料。其中男8例,女18例;年龄(77.9±5.2)岁;骨折部位:T119例,T1213例,L17例,L22例;椎体高度丢失超过其原高度的2/3。通过比较术前、术后1 d、末次随访时的疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、局部后凸角(LKA)观察疗效。结果所有患者术后获12(10,15)个月随访,无明显神经功能损伤及其他严重并发症发生。术后1 d和末次随访时的VAS评分[(2.9±0.7)、(2.2±0.7)分]、ODI(28.0%±4.8%、16.9%±4.0%)均较术前[(6.7±0.8)分、66.7%±6.0%]显著降低,末次随访时均较术后1 d继续降低,差异均有统计学意义(P<0.05)。术后1 d和末次随访时的LKA(18.1°±4.1°、19.5°±4.4°)均较术前(32.0°±5.2°)显著减小,差异均有统计学意义(P<0.05);末次随访时LKA与术后1 d比较差异无统计学意义(P>0.05)。结论PVDP治疗vsOVCF是一种有效的方法,可以缓解疼痛和改善局部后凸畸形,疗效满意。

Objective To investigate the clinical efficacy of percutaneous vertebral-disc plasty(PVDP)in the treatment of very severe osteoporotic vertebral compression fractures(vsOVCF).Methods A total of 26 patients with vsOVCF were treated by PVDP at Department of Spine Surgery,The Second Affiliated Hospital,Nantong University from November 2019 to August 2021.They were 8 males and 18 females with an age of(77.9±5.2)years.Fracture sites:T11 in 9 cases,T12 in 13 cases,L1 in 7 cases,and L2 in 2 cases.The loss of vertebral height exceeded 2/3 of its original height.The curative effects were evaluated by comparing the visual analogue scale(VAS),Oswestry disability index(ODI)and local kyphosis angle(LKA)at preoperation,1 day postoperation and the last follow-up.Results This cohort was followed up for 12(10,15)months.No obvious neurological damage or other serious complications occurred.The VAS scores[(2.9±0.7)and(2.2±0.7)points]and ODIs[28.0%±4.8%and 16.9%±4.0%]at 1 day postoperation and the final follow-up were significantly lower than the preoperative values respectively[(6.7±0.8)points and 66.7%±6.0%],and the values at the last follow-up were significantly lower than those at 1 day postoperation(P<0.05).The LKAs at 1 day postoperation and the last follow-up(18.1°±4.1°and 19.5°±4.4°)were significantly smaller than that before operation(32.0°±5.2°)(P<0.05),but there was no significant difference between 1 day postoperation and the last follow-up in LKA(P>0.05).Conclusion PVDP is an effective surgical treatment of vsOVCF,because it can relieve pain and improve local kyphosis with satisfactory clinical outcomes.