椎体后凸成形术治疗新鲜性与陈旧性骨质疏松椎体压缩骨折的疗效分析

目的: 探讨经皮椎体后凸成形术治疗新鲜性和陈旧性骨质疏松性椎体压缩骨折(OVCF)的疗效比较. 方法: 对2006年6月至2011年10月收治的应用经皮椎体后凸成形术(PKP)治疗的42例骨质疏松椎体压缩骨折患者进行回顾性分析,其中男5例,女37例;年龄60～86岁,平均(73.3±7.5)岁. 根据病程、MRI检查及是否经过系统的保守治疗将患者分为新鲜组和陈旧组. 应用视觉疼痛模拟评分(VAS)和日常活动能力评分(ADL)评估患者疼痛和日常活动能力的改善情况;同时利用手术节段X线测量计算伤椎椎体前壁及中间高度的恢复率及受伤节段脊柱的后凸矫正率. 结果: 所有患者获得随访,时间10～64个月,平均17个月. 新鲜组和陈旧组患者术前、术后1周及术后6个月的VAS评分和ADL评分分别进行两两比较,术后1周和6个月的评分均明显降低(P<0.05);术后6个月的VAS及ADL评分略高于术后1周的(P>0.05).而术后1周与术前的疼痛改善率及日常活动能力改善率相比较,新鲜组优于陈旧组(P<0.05).两组患者术后1周的伤椎前壁、中间高度的恢复率及后凸畸形矫正率比较,新鲜组明显优于陈旧组(P<0.05).结论: PKP对治疗新鲜性和陈旧性骨质疏松性椎体压缩骨折均有疗效,但对新鲜性骨质疏松性椎体压缩骨折疗效更明显,其在止痛、矫正后凸畸形及恢复椎体高度方面有明显优势,可改善患者生活质量.

Percutaneous kyphoplasty for the treatment of senior patient with acute and chronic osteoporotic vertebral compression fractures

Objective: To discuss the clinical effects of percutaneous kyphoplasty (PKP) for acute and chronic osteoporotic vertebral compression fractures(OVCF). Methods: From June 2006 to October 2011,42 senior patients with OVCF were treated with PKP. There were 5 males and 37 females,ranging in age from 60 to 86 years old with an average of (73.3±7.5) years old. The patients were divided into two groups (acute group and chronic group) according to the course,MRI and whether or not undergoing systematically conservative. VAS and ADL scoring systems were used to evaluate the pain and daily activities. X-ray was used to evaluate the vertebral height restoration rate and the kyphosis correction rate. Results: All patients were followed up from 10 to 64 months with an average of 17 months. At 1 week and 6 months after operation in two groups,VAS and ADL scores decreased significantly (P<0.05);VAS and ADL scores at 6 months after operation were higher than at 1 week after operation(P>0.05). But the improvement rates of the pain and daily activities of acute group were better than that of chronic group(P<0.05). At 1 week after operation,the restoration rate of anterior and middle vertebral height,the kyphotic correction rate in acute group were better than that of chronic group(P<0.05). Conclucsion: Using PKP to treat both acute and chronic osteoporotic vertebral compression fractures can get good effects,but acute patients can obtain better effects than chronic patients,it has obviously advantages of relieving pain,correcting kyphotic angle,recovering vertebral height.