经皮椎体后凸成形术中采用椎体支架系统治疗骨质疏松性椎体压缩性骨折

Treatment of osteoporotic vertebral compression fractures with vertebral body stenting system in percutaneous kyphoplasty

目的比较传统经皮椎体后凸成形术(PKP)与PKP术中采用椎体支架(VBS)系统治疗骨质疏松性椎体压缩性骨折(OVCF)的近期疗效。方法2019年7月—2020年12月,大连市第二人民医院收治老年单节段OVCF患者83例,其中47例采用传统PKP治疗(PKP组),36例在PKP术中采用VBS系统治疗(VBS组)。记录并比较2组患者手术时间、术中出血量、透视时间、球囊压力、骨水泥注入量、骨水泥渗漏情况、住院时间和住院费用,以及手术前后疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)、Beck指数、伤椎前缘高度、伤椎中部高度、伤椎前缘高度比、伤椎Cobb角、局部Cobb角。结果所有手术顺利完成,所有患者随访时间>1年。2组患者术后VAS评分、ODI、Beck指数、伤椎前缘高度、伤椎中部高度、伤椎前缘高度比、局部Cobb角均较术前有所改善,差异有统计学意义(P<0.05)。与PKP组比较,VBS组手术时间更长,术中透视时间更长,球囊压力更高,骨水泥注入量更多,骨水泥渗漏率更低,住院费用更高,伤椎Cobb角恢复更好,差异均有统计学意义(P<0.05)。结论2种术式均能缓解OVCF患者疼痛,PKP术中采用VBS系统能更好地纠正伤椎畸形,且骨水泥渗漏率低,但其手术时间、术中透视时间较长,住院费用较高。

Objective To compare the short-term efficacy of traditional percutaneous kyphoplasty(PKP)and PKP by vertebral body stenting(VBS)system for the treatment of osteoporotic vertebral compression fractures(OVCF).Methods From July 2019 to December 2020,83 elderly patients with single-segment OVCF were treated in Dalian Second People’s Hospital,of which 47 cases were treated with traditional PKP(PKP group),and the other 36 with PKP by VBS system(VBS group).The operation time,intraoperative blood loss,fluoroscopy time,balloon pressure,amount of bone cement injection,bone cement leakage,hospital stay and hospitalization expense of the patients in the 2 groups were recorded and compared,as well as the visual analogue scale(VAS)score,Oswestry disability index(ODI),Beck index,anterior edge height of injured vertebra,middle height of injured vertebra,anterior edge height ratio of injured vertebra,Cobb angle of injured vertebra and local Cobb angle before and after operation.Results All the operations were successfully completed,and all the patients were followed up for more than 1 year.The VAS score,ODI,Beck index,anterior edge height of injured vertebra,middle height of injured vertebra,anterior edge height ratio of injured vertebra and the local Cobb angle of the patients in the 2 groups after operation were all improved compared with those before operation,and the differences were statistically significant(P<0.05).Compared with PKP group,VBS group had longer operation time,longer intraoperative fluoroscopy time,higher balloon pressure,more amount of bone cement injection,lower bone cement leakage rate,higher hospitalization expense,and better recovery of Cobb angle of injured vertebra,all with a statistically significant difference(P<0.05).Conclusions Both of the methods can relieve the pain of OVCF patients.VBS system can better correct the deformity of injured vertebra,and the leakage rate of bone cement is low.However,the operation time,intraoperative fluoroscopy time and hospitalization expense are high.