经皮椎体后凸成形术与保守治疗急性和亚急性骨质疏松性椎体压缩骨折的随机对照研究

目的 比较经皮椎体后凸成形术(PKP)与保守治疗骨质疏松性椎体压缩骨折(OVCF)的疗效.方法 2007年7月至2010年7月采用PKP技术(PKP组)与保守疗法(保守治疗组)治疗164例OVCF患者,PKP组患者77例,男47例;女30例;年龄57～77岁,平均67岁;保守治疗组87例,男43例,女44例;年龄60～82岁,平均67岁.术后观察症状改善情况、椎体高度恢复率、后凸矫正率、骨水泥渗漏情况、疼痛、生理与心理结果;采用视觉模拟评分(VAS)评定疼痛程度;健康调查简表(SF-36)和Dallas问卷调查表(DPQ)测试评估生理和心理变化.结果 患者术后获6～12个月(平均9个月)随访.两组患者VAS评分术的和未次随访时比较差异均无统计学意义(P＞0.05),两组术后24 h内比较差异有统计学意义(P＜0.05).PKP组术前椎体前壁、后壁高度比为47.6%±22.4%,平均恢复27.9%;术前椎体后凸角为22.7°±10.7°,平均矫正12.6°,与保守治疗组比较差异均有统计学意义(P＜0.05).术后两组SF-36(标准生理组分、标准心理组分)、DPQ(日常活动、工作和娱乐、焦虑和沮丧、社会兴趣)、Barthel指数、简易精神状态量表(MMSE)比较差异均无统计学意义(P＞0.05).结论 与保守治疗组相比,早期采用PKP技术具有即刻减轻痛苦、早期起床活动、恢复椎体高度、矫正后凸畸形及减少并发症等优点.保守治疗组经过3～6个月严格保守治疗也能达到症状减轻,但椎体高度、后凸角恢复不佳.

Percutaneous kyphoplasty versus conservative treatment of acute and subacute osteoporotic vertebral compression fractures: a randomized controlled study

Objective To compare percutaneous kyphoplasty ( PKP ) and conservative treatment (CT) in terms of efficacy and safety for patients with osteoporotic vertebral compression fractures (OVCF) .Methods From July 2007 to July 2010, 164 patients with acute (within 2 weeks) or sub-acute (2 to 8 weeks) OVCF were enrolled in this study.They were randomly assigned into CT and PKP.In the PKP group, there were 47 men and 30 women, aged from 57 to 77 years (average, 67 years); In the CT group, there were 43 men and 44 women, aged from 60 to 82 years (average, 67 years).Improvement of symptoms, vertebral height restoration, correction of kyphosis, bone cement leakage, pain, physical and psychological outcomes were observed.Visual analog scale (VAS), SF-36 form and the Dallas questionnaire were adopted to evaluate the physiological and psychological changes.Results The patients obtained an average follow-up of 9 months (from 6 to 12 months) .A considerable degree of pain relief was obtained in both groups at postoperation and 3-month follow-up ( P ＜ 0.05 ).There was no significant difference between the 2 groups in VAS scores at preoperation and the last follow-up ( P ＞ 0.05 ), but a significant difference at 24 hours postoperation ( P ＜ 0.05) .In the PKP group, the average anterior vertebral body height was restored by 27.9% ( P ＜ 0.05) and the average vertebral kypbosis correction was 12.6° ( P ＜ 0.05).There were no significant differences between the 2 groups in postoperative scores in Health Survey Short Form (standard physical components and standard psychological components), Dallas Pain Questionnaire (activities of daily living, work and play, anxiety aod depression, social interests), Barthel index, Mini-Mental State Examination ( P ＞ 0.05) .Conclusions PKP is advantageous over CT in immediately relieving pain following an acute or subacute OVCF, better restoring the vertebral body height and correcting the kyphosis,early rehabilitation and lower complications.Although CT can relieve symptoms after 3 to 6 months, it is not as good as PKP in restoring the vertebral body height and correcting the kyphosis.