经皮椎体成形术和经皮椎体后凸成形术治疗骨质疏松性椎体骨折的临床疗效分析

目的：探讨经皮椎体成形术（percutaneousvertebroplasty，PVP）和经皮椎体后凸成形术（percutaneouskyphoplasty，PKP）治疗骨质疏松性椎体骨折（osteoporoticvertebralcompressionfractures，OVCF）的临床疗效。方法：对2007年1月至2010年2月收治的0VCF的患者进行回顾性分析，其中采用PVP治疗20例（PVP组），男8例，女12例，年龄54~81岁，平均（66．37±2．34）岁；采用PKP治疗20例（PKP组），男11例，女9例，年龄56-79岁，平均（65．12±3．21）岁。术后1、12周及1年采用疼痛视觉模拟评分（visualanalogueSCale，VAS）法、巴塞尔（Barthelindex，BI）评分方法对术后患者疼痛缓解程度及日常生活功能的改善情况进行评定；通过影像学资料观察责任椎的前缘高度、后凸角度（Cobb角）的变化。结果：PVP组出现椎体后缘骨水泥渗漏1例，但无任何·临床症状，渗漏的骨水泥未用手术方法处理。两组均无切口感染、深静脉血栓等并发症。所有患者获得1年以上随访。术后两组VAS、BI评分均较术前明显下降（P〈0．01），疼痛缓解明显，日常生活功能改善显著。术后l、12周及1年各时间段的VAS、BI评分差异无统计学意义（P〉0．05），两组之间差异无统计学意义（P〉0．05）。术前，术后1、12周及1年的责任椎体前缘高度、Cobb角变化在PVP组差异无统计学意义（P〉0．05）；在PKP组差异有统计学意义（P〈0．01），术后1、12周及1年比较差异无统计学意义（P〉0．05）。两组术后各时间段的责任椎前缘高度及Cobb角变化有统计学意义（P〈0．01）。结论：PVP和PKP均能明显缓解OVCF患者的疼痛，完全或部分恢复患者的日常生活功能；PKP在恢复责任椎前缘高度和矫正椎体后凸畸形方面具有明显的优势，尤其是对压缩程度较大的椎体高度恢复更明显。

Analysis of clinical effects of percutaneous vertebroplasty and percutaneous kyphoplasty in treating osteoporotic vertebral compression fracture

Objective: To explore the clinical outcomes of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty(PKP) in treating osteoporotic vertebral compression fracture (OVCF). Methods: From January 2007 to February 2010,the data of 40 patients with osteoporotic vertebral compression fracture underwent treatment were retrospectively analyzed. Of them,20 patients were treated with PVP (PVP group),there were 8 males and 12 females with an average age of (66.37±2.34)years old (54 to 81);20 patients were treated with PKP (PKP group),there were 11 males and 9 females with an average of (65.12±3.21) years old (56 to 79). Postoperative at 1 week,12 weeks,1 year,pain and daily life function were respectively assessed by visual analogue scale (VAS) and Barthel index (BI);and anterior height of responsibility vertebra,Cobb angle were measured by X-rays. Results: In PVP group,1 case complicated with bone cement leakage without clinical symptoms and no operation to treat. No postoperative infection and deep vein thrombosis were found between two groups. All patients were followed up more than 1 year,pain and daily life function has obviously improved than preoperative(P<0.01);and there was no significant difference on 1 week,12 weeks,1 year after operation(P>0.05);there was no significant difference between two groups (P>0.05). In PVP group,there was no significant difference in anterior height of responsibility vertebra,Cobb angle before and after operation;and in PKP group,postoperative data has obviously improved than preoperative(P<0.01),but there was no significant difference postoperative at 1 week,12 weeks,1 year(P>0.05);there was no significant difference between two groups at 1 week,12 weeks,1 year after operation. Conclusion: Both the methods can obviously relieve pain and completely or partly recover daily life function in treating OVCF. But PKP has advantages of recovery of anterior height of responsibility vertebra and correction of Cobb angle,especially for serious compression.