网袋成形术与椎体后凸成形术治疗骨质疏松性椎体压缩骨折的早期疗效比较

目的比较网袋成形术与椎体后凸成形术（PKP）治疗骨质疏松性椎体压缩骨折（OVCFs）的早期疗效。 方法回顾性分析杭州师范大学附属医院骨科2015年6月至2016年12月接受PKP或网袋成形术治疗的OVCFs患者114例，依据手术方法分为PKP组（59例，68椎）和网袋成形术组（55例，66椎）。比较两组患者术前骨折椎体压缩度、术后椎体高度恢复率、骨水泥渗漏发生率、骨水泥形态、骨水泥容积率及手术前后疼痛视觉模拟评分（VAS）和功能障碍指数（ODI）。 结果所有患者均获得随访，随访时间为（3.7±0.9）个月。两组患者术后1 d VAS、ODI评分较术前均有改善，差异有统计学意义（PKP组：Z=-10.143，F=1768.418，P<0.05；网袋成形术组：Z=-10.027，F=2192.838，P<0.05）。两组患者末次随访VAS、ODI评分相较术后1 d均有改善，差异均有统计学意义（PKP组：Z=-5.708，F=204.339，P<0.05；网袋成形术组：Z=-5.691，F=147.729，P<0.05）。PKP组（27.9%）患者骨水泥渗漏率高于网袋成形术组（13.6%，χ²=4.146，P<0.05)。PKP组骨水泥容积率[（22±5）%]低于网袋成形术组[（24±4）%，t=-2.659，P<0.05]。骨水泥形态PKP组主要为混合型（60.3%）及骨小梁型（39.7%），网袋成形术组主要为混合型（78.8%）及团块型（15.1%），差异有统计学意义（χ²=34.271，P<0.05）。随访期间共发现4例椎体再骨折（PKP组1例，网袋成形术组3例），两组差异无统计学意义。 结论网袋成形术治疗OVCFs可迅速缓解患者疼痛，提高活动能力，恢复椎体高度，相比PKP，能减少骨水泥渗漏的发生。

Early clinical outcome of vesselplasty and kyphoplasty in treatment of osteoporotic vertebral compression fractures

ObjectiveTo compare the early clinical outcomes of vesselplasty and kyphoplasty in the treatment of osteoporotic vertebral compression fractures. MethodsA retrospective analysis was performed in 114 patients with OVCFs underwent vesselplasty (59 cases, 68 vertebras) and kyphoplasty (55 cases, 66 vertebras) in Hangzhou Normal University affiliated Hospital between June 2015 to December 2016. Preoperative vertebral compression, vertebral height restoration, cement leakage, the shape of cement, the volume ratio of cement were compared between two groups. The Clinical effect were evaluated using the visual analogue scale (VAS) and Oswestry disability index (ODI). ResultsAll 57 cases received an average of (3.7±0.9) months follow-up (3-6 months). Compared with preoperative data, VAS and ODI score were improved significantly at 1 day after operation in both groups (PKP: Z=-10.143, F=1768.418, P<0.05; vesselplasty: Z=-10.027, F=2192.838, P<0.05). And at the last follow-up, the VAS and ODI score were improved significantly compared to the postoperative 1 day after operation in both groups (PKP: Z=-5.708, F=204.339, P<0.05; vesselplasty: Z=-5.691, F=147.729, P<0.05). PKP group associated with a higher rate of cement leakage than the vesselplasty group (27.9% vs. 13.6%, χ²=4.146, P<0.05) and a lower rate of cement volume ratio [(22±5)% vs. (24±4)%, t=-2.659, P<0.05]. In the aspect of cement shape, the dominant one in PKP group were mixed type (60.3%) and trabecular type (39.7%), while the vesselplasty group were mixed type (78.8%) and mass type (15.1%), the difference had statistically significant (χ²=34.271, P<0.05). Four patients (1 case in PKP group and 3 cases in vesselplasty group) had vertebra fractures during the follow-up period, the inter-group comparison has no significant differences. ConclusionsVesselplasty can rapidly relieve pain, improve mobility, restore the height of vertebral in patients with OVCFs. It is suitable for complex vertebral fractures as reducing the incidence of cement leakage contrasting to PKP.