弯角经皮椎体成形术是否手法复位的比较

Percutaneous curved vertebroplasty with or without manual reduction for osteoporotic vertebral compression fracture non-union

[目的]比较手法复位联合弯角经皮椎体成形术(percutaneous curved vertebroplasty,PCVP)与单纯PCVP治疗骨质疏松性椎体压缩性骨折不愈合(osteoporotic vertebral compression fracture non-union,OVCF-NU)的疗效。[方法]随机数表法将本院2020年6月—2022年9月收治的90例OVCF-NU患者分为两组,45例行手法复位联合PCVP治疗(复位组),另外45例未复位,仅行单纯PCVP治疗(未复位组)。比较两组围手术期、随访及影像学指标。[结果]复位组手术时间[(40.6±6.7)min vs(36.5±5.6)min,P=0.002]、术中X线曝光次数[(22.0±3.0)次vs(20.3±2.5)次,P=0.004]均显著多于未复位组,但是,两组骨水泥注入量、有效弥散倍数、骨水泥渗漏、术后下地时间、住院时间的比较差异均无统计学意义(P>0.05)。随访时间平均(16.0±2.0)个月,随时间推移,两组VAS评分、ODI评分显著减少(P<0.05);末次随访,复位组ODI评分显著优于未复位组[(13.3±3.4)vs(15.0±4.0),P=0.035]。影像方面,与术前相比,术后3 d和末次随访时,两组伤椎前缘高度比、伤椎后缘高度比、局部后凸Cobb角均显著改善(P<0.05)。术后3 d、末次随访复位组伤椎前缘高度比[(69.5±8.4)%vs(65.4±8.2)%,P=0.024;(68.0±8.0)%vs(64.5±7.8)%,P=0.042]、伤椎后缘高度比[(84.5±4.0)%vs(82.0±3.6)%,P=0.003;(82.7±4.2)%vs(80.2±3.8)%,P=0.005]均显著优于未复位组,末次随访复位组局部后凸Cobb角显著小于未复位组[(11.2±1.8)°vs(12.7±3.0)°,P=0.006]。[结论]手法复位联合PCVP治疗OVCF-NU安全有效,能快速缓解疼痛,有效恢复伤椎高度及后凸畸形。

[Objective]To compare the clinical outcomes of percutaneous curved vertebroplasty(PCVP)with or without manual reduction for osteoporotic vertebral compression fracture non-union(OVCF-NU).[Methods]A total of 90 patients with OVCF-NU admitted to our hospital from June 2020 to September 2022 were divided into two groups by random number table method.Of them,45 patients received PCVP combined with manual reduction(the reduction group),while other 45 patients received PCVP treatment alone without manual reduction(the non-reduction group).The perioperative period,follow-up and imaging data were compared between the two groups.[Results]The reduction group consumed significantly longer operative time[(40.6±6.7)min vs(36.5±5.6)min,P=0.002],associated with significantly greater intraoperative X-ray exposure times[(22.0±3.0)vs(20.3±2.5),P=0.004]than the non-reduction group,despite of that there were no significant differences in bone cement injection amount,effective bone cement diffusion ratio,bone cement leakage,postoperative ambulation time and hospital stay between the two groups(P>0.05).As time went during the follow-up period lasted for(16.0±2.0)months,the VAS scores and ODI score in both groups significantly decreased(P<0.05).At the last follow-up,the reduction group was significantly better than the non-reduction group in term of ODI score[(13.3±3.4)vs(15.0±4.0),P=0.035].With respect of imaging,the anterior vertebra height ratio,posterior vertebra height ratio and local kyphotic Cobb angle significantly improved in both groups 3 days after surgery and at the last followup compared with those preoperatively(P<0.05).The reduction group proved significantly superior to the non-reduction group in terms of the anterior vertebral height ratio[(69.5±8.4)vs(65.4±8.2),P=0.024;(68.0±8.0)vs(64.5±7.8),P=0.042],the posterior vertebral height ratio[(84.5±4.0)vs(82.0±3.6),P=0.003;(82.7±4.2)vs(80.2±3.8),P=0.005]at 3 days postoperatively and the last follow-up,as well as the local kyphotic Cobb angle[(11.2±1.8)°vs(12.7±3.0)°,P=0.006]at the last follow-up.[Conclusion]Manual reduction combined with PCVP in the treatment of OVCF-NU is safe and effective,which can quickly relieve the pain of patients and effectively restore the height and correct the kyphosis of the injured vertebra.