经皮弯角椎体成形与经皮椎体成形治疗骨质疏松性椎体压缩骨折的比较

目的比较经皮弯角椎体成形术(percutaneous curved vertebroplasty,PCVP)与经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compressive fractures,OVCF)的临床疗效。方法回顾性分析2018年3月~2019年3月60例OVCF手术治疗的临床资料,其中PCVP 30例,PVP 30例,比较2组手术时间、术中透视次数、骨水泥注入量、术后住院时间、术前后疼痛视觉模拟评分(Visual Analogue Score,VAS),以及骨水泥在骨折椎体内的分布情况、渗漏率。结果PCVP组手术时间和术中透视次数均明显短于或少于PVP组(29.4±2.1)min vs.(36.8±2.2)min,t=-13.333,P=0.000;(10.2±1.4)次vs.(15.1±1.5)次,t=-13.394,P=0.000]。PCVP组骨水泥分布优良率100.0%(30/30),明显高于PVP组53.3%(16/30)(Fisher精确检验,P=0.000);PCVP组骨水泥渗漏率6.7%(2/30),明显低于PVP组46.7%(14/30)(χ^2=12.273,P=0.000)。PCVP组与PVP组骨水泥注入量和术后住院时间差异均无显著性(3.6±0.3)ml vs.(3.7±0.3)ml,t=-1.811,P=0.075;(1.8±0.8)d vs.(2.1±1.0)d,t=-1.105,P=0.274]。2组VAS评分差异无显著性(F=0.313,P=0.578),不同时间点差异有显著性(F=472.703,P=0.000),分组和时间无交互作用(F=0.422,P=0.658)。2组均完成3~6个月随访,未出现脊髓神经损伤、伤椎再骨折及邻近椎体骨折等并发症。结论PCVP和PVP均可以明显改善OVCF患者的疼痛症状,但PCVP具有手术时间短、术中透视次数少、骨水泥分布好、骨水泥渗漏率低等优点。

Comparison Between Percutaneous Curved Vertebroplasty and Percutaneous Vertebroplasty for Osteoporotic Vertebral Compressive Fractures

Objective To compare the clinical effect of percutaneous curved vertebroplasty(PCVP)and percutaneous vertebroplasty(PVP)in the treatment of osteoporotic vertebral compressive fractures(OVCF).Methods A retrospective analysis was made on 60 elderly patients diagnosed as OVCF and treated with surgery in our hospital form March 2018 to March 2019.The patients were divided into PCVP group or PVP group,including 30 cases in PCVP group and 30 cases in PVP group.The operation time,number of X-ray exposure,bone cement injection volume,postoperative hospitalization time,Visual Analogue Score(VAS),bone cement distribution,and bone cement leakage were compared between the two groups.Results Compared with the PVP group,the operation time of the PCVP group was significantly shorter(29.4±2.0)min vs.(36.8±2.2)min,t=-13.333,P=0.000],the number of X-ray exposure was less10.2±1.4)times vs.(15.1±1.5)times,t=-13.394,P=0.000],the excellent and good rate of bone cement distribution was higher100.0%(30/30)vs.53.3%(16/30),Fisher’s exact test,P=0.000],and the leakage rate of bone cement was lower6.7%(2/30)vs.46.7%(14/30),χ^2=12.273,P=0.000].There was no significant difference in bone cement injection and postoperative hospitalization time between the PCVP group and the PVP group(3.6±0.3)ml vs.(3.7±0.3)ml,t=-1.811,P=0.075;(1.8±0.8)d vs.(2.1±1.0)d,t=-1.105,P=0.274].There was no significant difference in VAS score(F=0.313,P=0.578)between the two groups.The difference was statistically significant at different time points(F=472.703,P=0.000),and there were no interactions between groups and time(F=0.422,P=0.658).There were no complications such as spinal cord nerve injury,re-fracture of injured vertebrae and fracture of adjacent vertebral body in the two groups during the follow-up of 3-6 months.Conclusions Both PCVP and PVP can significantly relieve the pain of patients with OVCF.However,PCVP has the advantages of short operation time,less X-ray exposure,less trauma,good distribution of bone cement and low leakage rate of bone cement.