三种术式治疗骨质疏松性椎体骨折的疗效分析

目的 :探讨经皮空心带侧孔椎弓根钉钉道骨水泥强化术、经皮椎体成形术(percutaneous vertebroplasty,PVP)和经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松性椎体骨折(osteoporotic vertebral compression fractures,OVCF)的临床疗效。方法 :对2012年5月至2013年11月收治的90例OVCF患者的临床资料进行回顾性分析,按手术方法的不同将其分为经皮空心带侧孔椎弓根钉钉道骨水泥强化组(A组)、PVP组(B组)和PKP组(C组),每组30例。术前、术后1 d、3个月、1年采用疼痛视觉模拟评分法(visual analogue scale,VAS)对患者疼痛缓解程度进行评定;通过影像学资料观察责任椎的椎体压缩率、矢状面Cobb角的变化。结果:所有患者手术顺利,无切口感染、深静脉血栓等并发症。末次随访时A组中有2例患者术后留有轻度腰背痛;B组残留中度腰背痛7例,重度腰背痛4例,术后椎体再骨折2例;C组残留中度腰背痛5例,重度腰背痛3例,术后椎体再骨折4例。术后3组VAS评分、责任椎的椎体高度压缩率、Cobb角均较术前明显改善(P0.05)。术后1 d、3个月、1年各项目A组与B、C两组比较差异有统计学意义(P0.05),B组与C组比较差异无统计学意义(P0.05)。术后1 d、3个月、1年各项目在A组内差异无统计学意义(P0.05);在B组与C组内差异有统计学意义(P0.05)。结论:PVP和PKP对OVCF患者术后即刻止痛效果较经皮空心带侧孔椎弓根钉钉道骨水泥强化术明显,但PVP、PKP患者术后随访均残留不同程度腰背痛;经皮空心带侧孔椎弓根钉钉道骨水泥强化术在恢复责任椎前缘高度和矫正椎体后凸畸形、减少术后残余腰背痛方面具有明显的优势。

Analysis of clinical effects of three operative methods for osteoporotic vertebral compression fracture

Objective: To explore the clinical outcomes of percutaneous vertebroplasty(PVP), percutaneous kyphoplasty(PKP) and percutaneous hollow pedicle screw with lateral holes implanted bone cement reinforcement in treating osteoporotic vertebral compression fracture(OVCF). Methods: From May 2012 to November 2013, the clinical data of 90 patients with osteoporotic vertebral compression fracture were retrospectively analyzed. According to the different methods of operation, the patients were divided into three groups, including the percutaneous hollow pedicle screw with lateral holes implanted bone cement reinforcement group (group A), percutaneous vertebroplasty group (group B), percutaneous kyphoplasty group (group C), each group had 30 patients. Pre-operative, postoperative at 1 day, 3 months, 1 year, the back pain was assessed by visual analogue scale(VAS), and vertebral height compression ratio, Cobb angle were measured by X-rays. Results: All operations were successful and no complications such as postoperative infections and deep vein thrombosis were found. At the final follow-up, there were 2 patients with mild postoperative back pain in group A;7 patients with moderate postoperative back pain, 4 patients with severe postoperative back pain, 2 patients with postoperative vertebral refracture in group B;5 patients with moderate postoperative back pain, 3 patients with severe postoperative back pain, 4 patients with postoperative vertebral refracture in group C. Postoperative VAS, vertebral height compression ratio, Cobb angle of all patients have obviously improved than preoperative(P < 0.05). On 1 day, 3 months, 1 year after operation, there was significant difference between group A and group B, C(P < 0.05), there was no significant difference between group B and group C(P > 0.05). There was no significant difference in group A above items and different times(P > 0.05), and there was significant difference in group B, C above items and different times(P < 0.05). Conclusion: The effect of PVP and PKP on the immediately postoperative pain relief was more than percutaneous hollow pedicle screw with lateral holes implanted bone cement reinforcement in treating osteoporotic vertebral compression fracture, but, residual back pain can happen in different extent in the patients underwent PVP and PKP. Percutaneous hollow pedicle screw with lateral holes implanted bone cement reinforcement technique has obvious advantage in recovery of the vertebral height, correction of vertebral deformity, reduction of postoperative back pain.