PKP治疗老年骨质疏松性椎体压缩骨折的手术时机

目的]比较不同时机经皮穿刺椎体后凸成形术(PKP)治疗老年骨质疏松性腰椎压缩骨折的临床效果。方法]2014年12月~2016年12月,对114例老年单节段骨质疏松性椎体压缩骨折(OVCF)患者,均采用PKP术治疗,根据骨折至手术时间分为<7 d组55例,7~14 d组35例,15~28 d组24例。比较三组患者围手术期、随访与影像资料。结果]所有患者均顺利完成手术,三组患者在手术时间、住院时间和骨水泥使用量的差异均无统计学意义(P>0.05)。7~14 d组骨水泥渗漏率为5.71%,显著低于<7 d组的14.55%以及15~28 d组的12.50%,差异具有统计学意义(P<0.05)。所有患者均随访24个月以上,随时间推移,三组患者VAS评分、ODI指数均显著降低,而JOA评分显著升高(P<0.05)。术后3 d,<7 d组疼痛VAS评分、ODI指数显著低于7~14 d组和15~28 d组,差异具有统计学意义(P<0.05);相应时间点,三组间JOA评分差异无统计学意义(P>0.05)。末次随访所有患者均无明显疼痛症状,活动功能恢复良好,无邻椎骨折或伤椎再骨折发生。影像测量方面,三组患者术后Cobb角均显著小于术前,而伤椎前缘高度均显著大于术前(P<0.05)。术后24个月,15~28 d组Cobb角大于<7 d组和7~14 d组,而伤椎前缘高度比(RAH)显著低于<7 d组和7~14 d组,差异具有统计学意义(P<0.05)。结论]PKP术治疗老年OVCF能获得满意的近远期疗效,但骨折至手术时间<7 d疼痛改善效果更佳,手术时间7~14 d骨水泥渗漏率最低,手术时间15~28 d容易出现远期矫正丢失。

Surgical timing of percutaneous kyphoplasty for osteoporotic vertebral compression fracture in elderly

Objective]To compare the clinical outcomes of percutaneous kyphoplasty(PKP)in different time ranges after occurrence of osteoporotic vertebral compression fracture(OVCF)in the elderly.Methods]A total of 114 elderly patients who underwent PKP for OVCF in our hospital were enrolled into this study from December 2014 to December 2016.Based on the time elapsed between injury and operation,55 patients fell into the<7 days group,35 patients were into the 7~14 days group and 24 patients were into the 15~28 days group.The perioperative,follow-up and radiographic documentations were compared among the 3 groups.Results]The surgery accomplished smoothly in all patients,with no statistically significant differences among the 3 groups regarding operation time,volume of bone cement injected and hospital stay(P>0.05).The 7~14 days group had significantly lower incidence of cement leakage(5.71%)than the<7 days group(14.55%)and the 15~28 days group(12.50%),which was statistically significant(P<0.05).All the patients were followed up for more than 24 months.The VAS and ODI scores significantly decreased,while the JOA score significantly increased over time in the 3 groups(P<0.05).At 3 days after PKP,the<7 days group was marked significantly lower VAS and ODI score than the other two groups(P<0.05).However,there was no a statistically significant difference in JOA score among the 3 groups at any matching time point(P>0.05).At the latest follow up,all the patients in the 3 groups had no remarkable pain and recovered satisfactory motion function without refractures or new-onset adjacent vertebral fractures.In term of radiographic assessment,the Cobb’s angle significantly decreased,whereas the ratio of vertebral height significantly increased at all the time points after operation compared with those before operation in the 3 groups(P<0.05).At 24 months postoperatively,the 15~28 days group had significantly greater Cobb’s angle,whereas significantly less ratio of vertebral height than the<7 days group,and 7~14 days group,which proved statistically significant(P<0.05).Conclusion]The PKP is effective therapy for OVCF in the elderly,which dose achieve better pain relief performed in<7 days,less bone cement leakage conduced in 7~14 days,whereas is prone to correction loss in long term performed in 15~28 days.