PVP和PKP治疗骨质疏松性椎体压缩骨折疗效比较

目的比较经皮椎体成形术（percutaneous vertebroplasty,PVP）和经皮椎体后凸成形术（percutaneouskyphoplasty,PKP）治疗老年骨质疏松性椎体压缩骨折的疗效。方法 2008年6月至2011年1月,采用PVP和PKP技术共治疗骨质疏松性椎体压缩骨折患者87例（107椎）。其中45例（56椎）采用PVP治疗,男20例（24椎）,女25例（32椎）,年龄57～89岁,平均73.8岁;42例（51椎）采用PKP治疗,男18例（23椎）,女24例（28椎）,年龄56～90岁,平均72.7岁。观察术前、术后及末次随访时疼痛视觉模拟评分（visual analogue scale,VAS）变化,椎体高度变化,随访椎体高度丢失情况,记录骨水泥渗漏情况。方法 87例患者均顺利完成手术并获得随访,时间13～27个月,平均18.2个月。两组术后及末次随访时VAS评分均较术前有明显降低（P〈0.05）,两组间比较差异无统计学意义（P〉0.05）;术后椎体高度增加PKP组优于PVP组,末次随访时PKP组椎体高度丢失量较PVP组大,组间比较差异有统计学意义（P〈0.05）;PKP组骨水泥渗漏率17.6%,PVP组为35.7%,差异有统计学意义（P〈0.05）。结论 PVP和PKP治疗老年骨质疏松性椎体压缩性骨折均有同样满意的止痛效果;PKP恢复椎体高度优于PVP,远期高度也容易丢失;骨水泥渗漏发生率PKP组低于PVP组。

A Comparison of Percutaneous Vertebroplasty and Percutaneous Kyphoplasty for Senile Osteoporotic Vertebral Compression Fractures in Old Patients

Objective To compare the clinical results of percutaneous vertebroplasty(PVP) and percutaneous kyphoplasty(PKP) for osteoporotic vertebral compression fractures(OVCF) in old patients.Methods From Jun 2008 to Jan 2011,87 patients(106 vertebrae) with OVCF were treated with PKP or PVP.45 cases(56 vertebrae) had PVP which included 20 males(24 vertebrae) and 25 females(32 vertebrae),with the average age of 73.8 years(range,57 to 89 years);while 42 cases(51 vertebrae) had PKP which included 18 males(23 vertebrae) and 24 females(24 vertebrae),with the average age of 72.7 years(range,56 to 90 years).Visual analogue scale(VAS) and vertebral body height were evaluated pre-operatively,post-operatively and at the final follow-up.the vertebrae height loss were recorded and compared during follow-up.The PMMA leakage were also recorded.Results Operations in all the 87 patients were completed successfully.All the patients were followed up from 13 to 27 months with an average of 18.2 months.The postoperative and final follow up VAS scale compared with preoperative decreased significantly(P<0.05),but no significant difference were noted between 2 groups(P>0.05).Postoperative vertebral body height increased better in PKP group than in the PVP group,and more vertebrae height loss were noted in PKP group than in PVP group at the final follow up(P<0.05).PKP group had cement leakage in 17.6%and PVP group in 35.7%(P<0.05).Conclusion PVP and PKP for OVCF in old patient are reliable in pain relief.PKP patients can recover height of vertebral body better than PVP,but he height lost easily after opration.Bone cement leakage rate of PKP is lower than that of PVP.