手法复位联合经皮椎体成形术治疗合并椎体裂隙征骨质疏松性椎体压缩骨折

Manual reduction combined with percutaneous vertebroplasty for the treatment of osteoporotic vertebral compression fractures with intravertebral clefts

目的:探讨手法复位联合经皮椎体成形术治疗合并椎体裂隙征骨质疏松性椎体压缩骨折(OVCFs)的临床效果。方法:对2014年1月至2017年1月收治的合并椎体裂隙征骨质疏松性椎体压缩骨折94例患者进行回顾性分析,根据手术方式分为A、B两组。A组45例,采用单侧入路PVP治疗,其中男17例,女28例,年龄(75.35±11.82)岁,骨密度T值为(-4.28±0.65) g/cm^3;B组49例,采用手法复位联合单侧入路PVP治疗,其中男19例,女30例,年龄(76.79±9.64)岁,骨密度T值为(-4.33±0.72) g/cm^3。记录两组患者的手术时间、骨水泥注入量、并发症;分析两组患者术后1、12、18个月的VAS、ODI评分;比较两组患者术后即刻和术后12、18个月椎体高度、后凸Cobb角;观察骨水泥在椎体内的分布并计算其分布优良率。结果:两组患者的手术时间比较差异无统计学意义。骨水泥注入量A组为(8.42±1.24) ml,B组为(9.19±1.09) ml,两组差异有统计学意义(P<0.05)。两组患者术中均无脊髓神经根损伤,术后均无肺栓塞、骨水泥毒性反应、感染等并发症。骨水泥渗漏A组出现5例,B组4例,均未引起相应临床症状,未予特殊处理。骨水泥分布A组优25例,良19例,差1例,B组优45例,良4例;骨水泥分布优良率B组高于A组(P<0.05)。术前及术后1、12、18个月VAS、ODI评分A组分别为8.29±0.74、2.59±0.14、3.75±0.38、3.84±0.88和40.04±3.16、9.24±2.82、12.27±2.64、15.83±2.58,B组分别为8.22±0.82、2.54±0.19、2.81±0.23、2.82±0.45和39.98±2.05、9.16±2.10、9.46±2.41、9.76±2.46;术后1个月VAS、ODI评分两组比较差异无统计学意义(P>0.05),但术后12、18个月A组高于B组(P<0.05)。术前、术后即刻、术后12个月及18个月椎体高度、Cobb角A组分别为(59.17±1.42)%、(85.95±2.19)%、(75.27±3.45)%、(68.34±2.24)%和(23.83±3.37)°、(15.26±2.61)°、(17.63±2.16)°、(19.46±2.54)°,B组分别为(59.31±1.87)%、(89.19±2.53)%、(88.62±2.51)%、(88.59±2.62)%和(24.72±3.78)°、(14.91±2.28)°、(15.48±2.55)°、(15.86±2.81)°。术后即刻椎体高度B组大于A组,Cobb角B组小于A组(P<0.05),在随访中,B组椎体高度无明显变化,A组椎体高度塌陷(P<0.05)。结论:在治疗合并椎体裂隙征骨质疏松性椎体压缩骨折中,使用手法复位联合经皮椎体成形术较单独使用经皮椎体成形术,能够有效防止椎体再塌陷,提高患者的远期疗效。

Objective:To explore the therapeutic efficacy of manual reduction combined with percutaneous vertebroplasty in treating osteoporotic vertebral compression fractures(OVCFs)with intravertebral clefts.Methods:The clinical data of 94 patients with osteoporotic vertebral compression fractures with intravertebral clefts treated from January 2014 to January 2017 were retrospectively analyzed.The patients were divided into group A and group B according to different operative methods.In group A,45 patients were treated with unilateral approach PVP,including 17 males and 28 females,aged(75.35±11.82)years old,with a bone density T-value of(-4.28±0.65)g/cm^3;in group B,49 patients treated with manual reduction combined with unilateral approach PVP,including 19 males and 30 females,aged(76.79±9.64)years old,with a bone density T-value of(-4.33±0.72)g/cm^3.The operation time,bone cement injection volume and postoperative complications of two groups were recorded.The VAS and ODI scores of two groups were analyzed respectively at 1,12,18 months after operation.Vertebral height and kyphosis Cobb angle of two groups were compared immediately after surgery and 12,18 months after operation.The distribution of bone cement in the vertebral body was observed and its distribution excellent rate was calculated.Results:There was no significant difference in operation time between two groups.The amount of bone cement injection was(8.42±1.24)ml in group A and(9.19±1.09)ml in group B,and the difference between two groups was statistically significant(P<0.05).No spinal nerve root injury during operation and no complications including pulmonary embolism,bone cement toxicity and infection were found in two groups.There were 5 cases of bone cement leakage in group A and 4 cases in group B,which did not cause corresponding clinical symptoms and were not treated additionally.The distribution of bone cement in group A was excellent in 25 cases,good in 19 cases,poor in 1 case and in group B was excellent in 45 cases,good in 4 cases.The distribution excellent rate of bone cement was higher in group B than in group A(P<0.05).The VAS and ODI scores before operation and 1,12,18 months after operation were 8.29±0.74,2.59±0.14,3.75±0.38,3.84±0.88 and 40.04±3.16,9.24±2.82,12.27±2.64,15.83±2.58 in group A,8.22±0.82,2.54±0.19,2.81±0.23,2.82±0.45 and 39.98±2.05,9.16±2.10,9.46±2.41,9.76±2.46 in group B.There was no significant difference in VAS and ODI scores at 1 month after operation between two groups(P>0.05),but group A was higher than group B at 12 and 18 months after operation(P<0.05).The vertebral height and Cobb angle before surgery,immediately after surgery,and 12,18 months after surgery in group A were(59.17±1.42)%,(85.95±2.19)%,(75.27±3.45)%,(68.34±2.24)%and(23.83±3.37)°,(15.26±2.61)°,(17.63±2.16)°,(19.46±2.54)°,and in group B were(59.31±1.87)%,(89.19±2.53)%,(88.62±2.51)%,(88.59±2.62)%and(24.72±3.78)°,(14.91±2.28)°,(15.48±2.55)°,(15.86±2.81)°.Vertebral height Immediately after surgery was greater in group B than in group A and Cobb angle in group B was smaller than in group A(P<0.05).During follow-up,there was no significant change in vertebral height in group B,while vertebral body recollapse in group A(P<0.05).Conclusion:In the treatment of osteoporotic vertebral compression fractures with intravertebral clefts,the manual reduction combined with PVP is more effective than single PVP,which can effectively prevent vertebral body recollapse and improve the long-term efficacy of patients.