经皮椎体后凸成形术与经皮椎体成形术治疗骨质疏松性胸腰段骨折的疗效对比研究

目的比较研究经皮椎体后凸成形术(PKP)与经皮椎体成形术(PVP)治疗骨质疏松性胸腰段椎体骨折的临床疗效。方法回顾性分析2009年3月至2012年10月间治疗的53例病患资料,分为PKP(32例)及PVP(21例)两种治疗组。比较两组单椎体手术操作时间、X线暴露时间、骨水泥注射量、渗漏情况、椎体压缩率、Cobb角、疼痛视觉模拟评分(VAS)评分和功能障碍指数(ODI)评分。结果患者均顺利完成手术,术后随访15~26个月,平均18.2个月。PKP组较PVP组单椎体手术操作时间、X线暴露时间和骨水泥注射量显著提高。PKP组术后和随访时椎体压缩率及Cobb角无统计学差异,但较术前明显改善。PVP组术前、术后和随访时椎体压缩率及Cobb角无明显变化。术后PKP组压缩率及Cobb角的改善效果优于PVP组。PKP组发生2例骨水泥渗漏,PVP组发生3例骨水泥渗漏,两组发生渗漏的患者均无神经症状。PKP与PVP组患者术后及随访时的VAS、ODI评分差异无统计学意义,但均较术前明显改善。结论 PKP及PVP均是临床治疗骨质疏松性胸腰段骨折的有效手段,两者均能改善临床症状,而PKP在恢复椎体高度、后凸畸形及减少骨水泥外渗方面较优。

Comparative analysis for treatment of osteoporotic thoracolumbar fracture with percutaneous kyphoplasty and percutaneous vertebra-plasty

Objective To compare the clinical effect of percutaneous kyphoplasty（PKP）and percutaneous（PVP）vertebraplasty in the treatment of osteoporotic thoracolumbar fracture. Methods 53 patients were treated with PKP（32 patients）or PVP（21 patients）in our hospital from March 2009 to October 2012. The operation time,X - ray exposure time,injection dose and leakage occurrence were compared between these two groups. The vertebral compression rate and the Cobb angle were evaluated by X - ray. The VAS and ODI scoring systems were employed to compare the pain and quality of life respectively in each group. Results All operations were plain sailing. The average follow - up period was 18. 2（15 ~ 26）months. The PKP group had a much longer operation and X - ray exposure time than PVP group,but also did injection dose. The vertebral compression rate and the Cobb angle after PKP showed no statistical difference in comparison with those in follow - up,which were better than those of before operation. And for PVP group,there were no significant differences of the vertebral compression rate and the Cobb angle be-tween preoperation and postoperation. Two leakage cases occurred in PKP and three in PVP without neurological deficiency. The VAS or ODI scores after operation presented no significant difference in comparison with those in follow - up between PKP and PVP group,but which were bet-ter than those before operation. The vertebral compression rate and the Cobb angle in the PKP group were better than that in the PVP group. Con-clusion In the treatment of osteoporotic thoracolumbar fracture,PKP and PVP are both the effective surgical techniques to improve the clinical symptom. However,PKP is superior to PVP on the recovery of the vertebral body height and kyphosis after PKP is superior to those after PVP,and also in the reduction of the injective leakage rate.