脊柱矢状面失衡对骨质疏松性椎体压缩性骨折椎体成形术疗效的影响

目的探讨经皮椎体成形术(PVP)治疗骨质疏松性椎体压缩性骨折(OVCF)时术后患者脊柱矢状面平衡状态对手术疗效的影响。方法纳入2011年6月—2013年6月在广州中医药大学第一附属医院接受PVP治疗的OVCF患者,采用Barrey法依据患者术后脊柱矢状面平衡状态分为生理平衡组(A组)、代偿平衡组(B组)和失平衡组(C组)。于术后12个月随访时分别采用疼痛视觉模拟量表(VAS)评分评价腰背痛、Barthel日常活动(activity of daily life,ADL)评分评价活动功能、Berg评分评价机体平衡控制能力。统计因新发OVCF再次入院接受治疗以及术后12个月随访胸腰段畸形Cobb角增加10°的发生率。结果各组基线特征(性别、年龄、伤椎节段分布、骨折发生次数、骨密度、术前疼痛评分及活动功能)差异无统计学意义。术后12个月随访时,腰背痛和活动功能均显示A组最优、B组次之、C组最差,3组间比较差异均有统计学意义(P0.05);机体维持平衡能力A、B组间无差异,但A、B组均优于C组且差异有统计学意义(P0.05)。A组再次出现OVCF和胸腰段畸形Cobb角增大10°的发生率均低于B、C组,差异有统计学意义(P0.05)。结论 PVP治疗OVCF时,术后脊柱矢状面失衡的患者手术疗效较差。应注意对术后矢状面失衡患者给予关注(延长卧床时间、佩戴支具、定期随诊),一旦出现相关信号症状(突发患部疼痛、活动功能下降等),应尽快对症处理。

Influence of spinal sagittal imbalance on therapeutic effect of percutaneous vertebraplasty for treatment of osteoporotic vertebral compression fractures

Objective To evaluate the influence of spinal sagittal imbalance on the therpeutic effect of percutaneous vertebroplasty(PVP) for treatment of osteoporotic vertebral compression fracture(OVCF). Methods The patients who underwent PVP for OVCFs from June 2011 to June 2013 retrospectively were reviewed. The patients were divided into 3 groups based on the spinal sagittal imbalance by Barrey''s method: Group A(balance), Group B(compensated balanced), Group C(unbalance). The following parameters were recorded at 12 months postoperation: visual analogue scale(VAS) score, Barthel activity of daily life(ADL) index, Berg index, and incidence of new OVCFs or height loss of augmented vertebra (Cobb''s angle of the fractured vertebrae >10°). Results There were no differences in baseline covariates between groups (gender, age, vertebral segment, fracture frequency, bone mineral density, VAS score at pre-operation). Group A showed significantly better VAS and ADL improvement than groups B and C(P< 0.05), group B was better than group C(P< 0.05). Groups A and B showed significantly better Berg improvement than group C(P< 0.05), however, there was no significant difference between group A and group B. The incidence of new OVCF and recollapse of augmented vertebra in group A were significantly lower than those in groups B and C(P< 0.05). Conclusion Spinal sagittal imbalance significantly influence the therpeutic effect of PVP for OVCFs. Patients in imbalance group probably need a longer time of stay in the bed, brace wear, and long term follow-up, be alert for signs and symptoms such as sudden back pain and maladjustment of body activity function.