老年骨质疏松性脊柱压缩骨折手术治疗的临床研究

Clinical study on the surgical treatment of osteoporotic spinal compression fractures in the elderly

目的探讨老年骨质疏松性脊柱压缩骨折(OVCF)不同手术方式治疗的效果及安全性。方法选取2019年1月-2021年10月贵航平坝医院收治的老年OVCF患者86例,按随机数字表法分为PVP组与PKP组各43例。PVP组采用经皮椎体成形术,PKP组采用经皮椎体后凸成形术,观察至术后6个月,对比2组手术情况、疼痛程度、脊柱功能、伤椎高度、Cobb角及术后并发症。结果PKP组术中出血量、骨水泥灌注量少于PVP组,手术时间短于PVP组,差异有统计学意义(P<0.05);术后6个月,2组VAS评分、ODI均低于术前,差异有统计学意义(P<0.05),组间比较差异无统计学意义(P>0.05);术后6个月,2组伤椎前缘高度、前缘高度/后缘角度均高于术前,且PKP组高于PVP组,2组Cobb角低于术前,且PKP组低于PVP组,差异有统计学意义(P<0.05);PVP组骨水泥渗漏发生率高于PKP组,PKP组椎体高度再丢失发生率高于PVP组,差异有统计学意义(P<0.05)。结论PVP与PKP治疗老年OVCF均能取得良好效果,其中PKP更利于伤椎高度、Cobb角度的恢复,但术后易发生椎体高度再丢失,而PVP术后骨水泥渗漏发生风险更高。

Objective To investigate the effect and safety of different surgical treatments of osteoporotic spinal compression fracture(OVCF)in the elderly.Methods 86 elderly OVCF patients admited to our hospital from January 2019 to October 2021 were divided into PVP and PKP groups in 43 patients.Percutaneous vertebroplasty was performed in the PVP group and percutaneous vertebral kyphoplasty in the PKP group.At 6 months after surgery,the surgical conditions,pain degree,spinal function,injured vertebral height,Cobb angle,and postoperative complications were compared between the two groups.Results The amount of bleeding and bone cement perfusion in PKP group was less than that in PVP group,and the operation time was shorter than that in PVP group,the difference was statistically significant(P<0.05);Six months afer operation,the VAS score and ODI of the two groups were lower than those before operation,the difference was statistically significant(P<0.05),and there was no statistically significant difference between the two groups(P>0.05);Six months after operation,the anterior edge height,anterior edge height/posterior edge angle of the injured vertebra in the two groups were higher than those in the PVP group,and the Cobb angle in the two groups was lower than that in the PVP group,and the difference was statistically significant(P<0.05);The incidence of bone cement leakage in PVP group was higher than that in PKP group,and the incidence of vertebral height re-loss in PKP group was higher than that in PVP group,the difference was statistically significant(P<0.05).Conclusion Both PVP and PKP can achieve good results in the treatment of elderly OVCF.PKP is more conducive to the recovery of injured vertebral height and Cobb angle,but it is easy to lose vertebral height after operation,and the risk of bone cement leakage after PVP is higher.