PVP治疗急性与非急性期含椎体裂隙的老年骨质疏松性椎体压缩骨折疗效比较

Comparison of efficacy of PVP on elderly osteoporotic vertebral compression fractures with intravertebral cleft in acute and non-acute phase

目的 比较经皮椎体成形术(Percutaneous vertebroplasty,PVP)治疗急性与非急性期含椎体裂隙的骨质疏松性椎体压缩骨折的疗效。方法 回顾性分析自2019-10—2021-03行PVP治疗的53例含椎体裂隙的骨质疏松性椎体压缩骨折,根据病程时间分为急性期组(病程<2周,n=23)与非急性期组(病程≥2周,n=30)。比较两组骨水泥注入量、骨水泥渗漏率、骨水泥弥散分布情况,以及术后2 d、12个月疼痛VAS评分、伤椎前缘高度比值、伤椎Cobb角。结果 两组骨水泥注入量、骨水泥渗漏率差异无统计学意义(P>0.05),但急性期组骨水泥弥散分布多为海绵状,非急性期组多为团块状。53例均获得随访,随访时间12~30个月,平均22.6个月。两组术后疼痛VAS评分、伤椎前缘高度比值及伤椎Cobb角均较术前改善(P<0.05),急性期组术后2 d及术后12个月伤椎前缘高度比值和Cobb角矫正恢复情况均优于非急性期组,差异有统计学意义(P<0.05),但两组疼痛VAS评分方面差异无统计学意义(P>0.05)。结论 PVP治疗急性与非急性期含椎体裂隙的老年骨质疏松性椎体压缩骨折均能取得良好疗效,但急性期患者在骨水泥弥散分布情况、伤椎前缘高度及伤椎Cobb角的矫正效果方面更优,因此,对于含椎体裂隙的骨质疏松性椎体压缩骨折,建议及早行PVP治疗。

Objective To compare the efficacy of percutaneous vertebroplasty(PVP)on osteoporotic vertebral compression frac-tures(OVCFs)with intravertebral cleft in acute and non-acute phase.Methods A retrospective study was performed on 53 patients who underwent PVP to treat OVCFs with intravertebral cleft from October 2019 to March 2021.Based on the duration of the disease,the patients were divided into acute phase group(disease duration<2 weeks,n=23)and non-acute phase group(disease duration≥2 weeks,n=30).The amount of bone cement injected,cement leakage rate and cement distribution were com-pared between two groups,as well as the VAS score,anterior height ratio and Cobb angle of the injured vertebra at 2 days and 12 months after surgery.Results There was no statistically significant difference in the amount of bone cement injected and the leakage rate between the two groups(P>0.05),but the distribution of bone cement in the acute phase group was mostly spongy,while in the non-acute phase group,it was mostly clumpy.All patients were followed up for 12-30 months,with an aver-age of 22.6 months.The postoperative VAS score,anterior height ratio and Cobb angle of the injured vertebra in both groups im-proved compared to before surgery(P<0.05).The acute phase group had better recovery of anterior height ratio and Cobb angle correction 2 days and 12 months after surgery than the non-acute phase group,with statistical significance(P<0.05),but there was no statistically significant difference in VAS score between the two groups(P>0.05).Conclusion PVP has good efficacy on elderly OVCFs with intravertebral cleft in both acute phase and non-acute phase.However,patients in the acute stage have better correction effects in terms of bone cement distribution,anterior height ratio,and Cobb angle of the injured vertebra.There-fore,early treatment is recommended for elderly OVCFs with intravertebral cleft.