椎体成形术和传统法治疗骨质疏松性椎体压缩骨折疗效的对比研究

目的研究并比较椎体成形术(PVP)和保守疗法治疗骨质疏松性椎体压缩骨折的临床疗效。方法骨质疏松性椎体新鲜压缩骨折83例共104节,非随机分为2组,组1共44例58节用PVP治疗,组2共39例46节用保守治疗,比较两组治疗后随访期内疗效及椎体高度变化。结果组1患者44例PVP后1周疼痛均得到缓解,视觉疼痛评分(VAS)平均分值从术前8.5下降至2.6(平均下降5.9)。组2患者39例保守治疗后1周VAS分值无变化,在治疗后1周、1和3个月时。组1的VAS分值明显低于组2(P<0.01),6个月时两组差异无统计学意义(P>0.05)。平均随访8.9个月,组1有新发骨折3例3节,组2有2例2节,两组比较无显著差异无统计学意义(P>0.05)。PVP后1周椎体高度恢复平均为前缘2.2mm,中央2.3mm,后缘高度无变化,随访3、6个月椎体前缘、中央高度与PVP后1周时无差异(P<0.01)。保守治疗后1周椎体前缘、中央及后缘高度与治疗前比较无显著改变,3个月时椎体高度丢失平均为前缘1.9mm,中央2.1mm,6个月时与3个月无差异。在治疗3个月后,组1椎体高度明显高于组2(P<0.01)。结论PVP可迅速缓解疼痛,明显缩短病程,但6个月后两组疗效无显著差异;PVP可使新鲜压缩椎体的前缘和中央高度得到部分恢复,可显著预防椎体进一步塌陷;保守治疗在3个月内椎体高度可进一步丢失;PVP后新发骨折可能是骨质疏松症的自然发病过程。

Percutaneous vertebroplasty and conservative therapy for osteoporotic vertebral compression fractures: a clinical comparative study

Objective To evaluate the clinical efficacies of percutaneous vertebroplasty and conservative therapy in patients with osteoporotic vertebral compression fractures. Methods One hundred and four vertebrae in 83 patients with osteoporotic compression fractures were shown by MRI, CT and plain radiography. Forty four patients with 58 vertebrae were assigned to group 1 treated by PVP, and 39 patients with 46 vertebrae were assigned to group 2 treated by conservative therapy. The efficacies of two groups were evaluated by measuring the heights of vertebrae on the lateral plain films during follow-up. Results No serious complications occurred with PVP. Pain relief was obtained in all of 44 patients and VAS score decreased from 8.5 before the procedure to 2.6 at 1 week after PVP(improvement of 5.9). Pain still remained in all 39 patients at 1 week after conservative treatment. Improvement was significantly greater in the group 1 than in group 2 at 1 week, 1 month and 3 months, but no difference at 6 months after treatment (P > 0.05). Within 8.9 months of mean follow-up, 3 new fractures occurred in 3 patients in group 1, 2 new fractures occurred in 2 patients in group 2, showing no significant difference. The average increase in vertebral body height on the X-ray plains at 1 week after PVP was 2.2 mm anteriorly, 2.3 mm centrally and unchanged posteriorly. Comparing with the plain film at 1 week after PVP, the heights of vertebrae showed no significant difference at 3 and 6 months of follow-up respectively the heights of vertebrae were unchanged at 1 week after conservative therapy. Average reduction in vertebral body height was 1.9 mm anteriorly, 2.1 mm centrally, unchanged posteriorly at 3 months, but no more collapse at 6 months after conventional treatment. The vertebral body height was significantly higher in the group 1 than in group 2 at 3 months after treatment. Conclusions PVP is aneffective and safe procedure for treating persistent painful osteoporotic vertebral compression fractures and shortening the course of disease. Pain relief showed no difference at 6 months follow up with conventional treatment\ a outcoming with increase of vertebral body height and preventing further collapse of the vertebra. New fractures following vertebroplasty may actually represent presence of osteoporosis rather than a complication of the procedure.