不同椎体成形术治疗老年骨质疏松性脊柱骨折的疗效

Different vertebroplasty procedures in osteoporotic spinal fractures in the elderly

目的:观察比较不同椎体成形术在老年骨质疏松性脊柱骨折中应用效果及对血清脂联素(APN)、瘦素(leptin)表达的影响,为临床术式选择提供参照。方法:选取2017年8月至2020年8月老年骨质疏松性脊柱骨折患者105例,按照治疗术式不同分为A组(n=53)、B组(n=52)。A组行骨填充网袋经皮椎体成形术(PVP),B组行经皮椎体后凸成形术(PKP)。比较两组并发症、疗效、围手术期手术指标,术前、术后1周、术后1个月血清APN、leptin表达以及术前、术后1个月、术后12个月视觉模拟评分量表(VAS)评分、Oswestry功能障碍指数(ODI)、日常生活活动能力量表(BI)评分。结果:A组手术时间较B组短,透视次数较B组少(P<0.05);与术前比较,两组术后1周、1个月血清APN水平均提高,血清leptin表达均降低(P<0.05),但两组间比较,差异无统计学意义(P>0.05);A组术后12个月总有效率92.45%与B组的88.46%比较,差异无统计学意义(P>0.05);A组术后并发症发生率为1.89%,明显低于B组的15.38%(P<0.05);两组术后1个月、12个月VAS评分、ODI均较本组术前降低,BI评分均较本组术前提高(P<0.05),但组间比较,差异无统计学意义(P>0.05)。结论:骨填充网袋PVP与PKP均可有效调节老年骨质疏松性脊柱骨折患者血清APN、leptin表达,改善疼痛、功能状况及日常生活能力,疗效显著,但前者手术更为便捷,透视次数及并发症更少,安全性更高。

Objective:To observe and compare the application effects of different vertebroplasty in elderly osteoporotic spine fractures and their effects on serum adiponectin(APN),and leptin expression,so as to select clinical procedures.Methods:One hundred and five elderly patients with osteoporotic spine fractures from August 2017 to August 2020 were selected and divided into group A(n=53)and group B(n=52)according to the treatment procedure.group A underwent percutaneous vertebroplasty(PVP)with bone filled mesh bags and group B underwent percutaneous posterior kyphoplasty(PKP).Complications,efficacy,perioperative surgical indices,as well as preoperative,1 week postoperative and 1 month postoperative serum APN,leptin expression,and preoperative,1 month and 12 months postoperative visual analogue scale(VAS)scores,Oswestry dysfunction index(ODI)and activities of daily living(BI)scores were compared between the two groups.Results:Group A had a shorter operative time and fewer fluoroscopies than group B(P<0.05);compared with the preoperative period,serum APN levels increased and serum leptin expression decreased in both groups at 1 week and 1 month postoperatively(P<0.05),but the difference was not statistically significant between the two groups(P>0.05).The total effective rate of group A was 92.45%at 12 months after surgery compared with 88.46%of group B,and the difference was not statistically significant(P>0.05);the postoperative complication rate of group A was 1.89%,which was significantly lower than 15.38%of group B(P<0.05);the preoperative VAS scores and ODI of the two groups were higher than those of this group at 1 month and 12 months after surgery,the BI score was increased compared with this group before the operation(P<0.05),but the difference between the groups was not statistically significant(P>0.05).Conclusion:Both bone filled mesh bag PVP and PKP are effective in modulating serum APN and leptin expression in elderly patients with osteoporotic spinal fractures,which can improve pain,functional status and ability to perform daily activities with significant efficacy,but the former is a more convenient procedure with less fluoroscopy and fewer complications and it has a higher safety profile.