X线及磁共振成像在不同分型骨质疏松性胸腰椎骨折患者经皮后凸成形术中的效果评价

Effect of X-ray and magnetic resonance imaging in treating patients with different types of osteoporotic thoracolumbar fracture by percutaneous kyphoplasty

目的 探讨X线及磁共振成像(MRI)在不同分型骨质疏松性胸腰椎骨折患者经皮后凸成形术(PKP)中的应用效果。方法 选取136例骨质疏松性胸腰椎骨折患者为研究对象,依照MRI矢状位异常信号和X线侧位片椎体形态特点分为Ⅰ型组、Ⅱ型组和Ⅲ型组。3组患者均实施靶点穿刺PKP,比较3组术前和术后的疼痛视觉模拟评分(VAS)、伤椎高度、Oswestry功能障碍指数问卷表(ODI)、伤椎Cobb角。结果 Ⅰ型组、Ⅱ型组、Ⅲ型组患者术后3 d、术后1周及术后半年VAS评分比较,差异均无统计学意义(P>0.05);3组患者术后1周和术后半年的VAS评分均低于同组术后3 d,差异有统计学意义(P<0.05)。术前、术后1周和术后半年时,Ⅱ型组、Ⅲ型组椎体高度大于Ⅰ型组,差异有统计学意义(P<0.05);术前、术后1周和术后半年时,Ⅱ型组、Ⅲ型组患者椎体高度比较,差异无统计学意义(P>0.05)。Ⅰ型组、Ⅱ型组、Ⅲ型组患者术后3 d及术后半年的ODI指数比较,差异均无统计学意义(P>0.05);3组患者术后半年的ODI指数均低于同组术后3 d,差异有统计学意义(P<0.05)。Ⅰ型组、Ⅱ型组、Ⅲ型组患者术后3 d和术后半年的伤椎Cobb角比较,差异无统计学意义(P>0.05)。结论 采用X线及MRI评估不同分型骨质疏松性胸腰椎骨折患者病情并指导靶点穿刺PKP治疗具有较高的临床应用价值,其中Ⅱ型和Ⅲ型患者临床疗效优于Ⅰ型患者。

Objective To explore the application effect of X-ray and magnetic resonance imaging(MRI)in the treatment of patients with different types of osteoporotic thoracolumbar fracture by percutaneous kyphoplasty(PKP).Methods A total of 136 patients with osteoporotic thoracolumbar fracture were selected as research objects,and they were divided into typeⅠgroup,typeⅡgroup and typeⅢgroup according to sagittal abnormal signal of MRI and morphological characteristics of vertebral body on X-ray lateral films.Patients in the three groups were conducted with targeted puncture PKP,and the Visual Analogue Scale(VAS)of pain,vertebral height,Oswestry Dysfunction Index(ODI)questionnaire and vertebral Cobb angle before and after operation were compared among three groups.Results There were no significant differences in VAS scores among typeⅠ,typeⅡand typeⅢgroups at 3 days,1 week and 6 months after surgery(P>0.05);the VAS scores at 1 week and 6 months after surgery in the three groups were significantly lower than those in the same group at 3 days after surgery(P<0.05).At the time points of before surgery,1 week and 6 months after surgery,the vertebral height of the typeⅡand typeⅢgroups was significantly higher than that of the typeⅠgroup(P<0.05);there was no significant difference in vertebral height between typeⅡand typeⅢgroups at the time points of before surgery,1 week and 6 months after surgery(P>0.05).There were no significant differences in the ODI index among the typeⅠ,typeⅡand typeⅢgroups at 3 days and 6 months after surgery(P>0.05);the ODI index in the three groups at 6 months after surgery was significantly lower than that in the same group at 3 days after surgery(P<0.05).There was no significant difference in the Cobb angle of the injured vertebrae among the typeⅠ,typeⅡand typeⅢgroups at 3 days and 6 months after surgery(P>0.05).Conclusion The X-ray and MRI show high clinical application value in evaluating the condition of patients with different types of osteoporotic thoracolumbar fracture and guiding targeted puncture PKP,and typeⅡand typeⅢpatients have better clinical efficacy than type I patients.