经皮椎体后凸成形术对新鲜与陈旧性骨质疏松性椎体压缩骨折的临床疗效分析

目的　探讨经皮椎体后凸成形术（percutaneouskyphoplasty，PKP）治疗新鲜与陈旧性骨质疏松性椎体压缩骨折（osteoporotic vertebral compression fracture，OVCF）的临床效果。方法　选取滨州医学院附属医院脊柱外科2019年6月至2021年1月收治的104例经PKP治疗的OVCF患者的143个椎体。根据患者病程及MRI的T₁、T₂信号强度分为陈旧组与新鲜组。新鲜组共62例71个椎体，男11例，女51例，年龄（70.21±8.05）岁；陈旧组共42例72个椎体，男4例，女38例，年龄（70.05±5.17）岁。所有患者均在G臂透视下完成手术。记录两组围术期相关指标、椎体前缘高度、矢状位后凸Cobb角、腰痛视觉模拟评分（Visual Analogue Scale，VAS）、Oswestry功能障碍指数（Oswestry disability index，ODI）及相关并发症。计量资料组间比较采用独立样本t检验，计数资料组间比较采用χ²检验。结果　所有患者手术顺利完成，两组104例中发生骨水泥渗漏10例：新鲜组9例，其中椎间隙渗漏4例，椎旁渗漏5例；陈旧组1例，为椎间隙渗漏。术后1年相邻椎体骨折，新鲜组1例，陈旧组5例，椎体前缘高度压缩范围均小于10%，经保守治疗治愈，两组间差异有统计学意义（χ²=4.878，P<0.05）。新鲜组手术时间短于陈旧组［（44.24±17.32）min比（56.12±30.05）min，t=-2.552，P<0.05］；新鲜组单个椎体骨水泥注入量多于陈旧组［（3.90±1.07）ml比（3.53±0.90）ml］，差异有统计学意义（t=2.262，P<0.05）。随访13～15个月，两组术后VAS评分、ODI、椎体前缘高度及Cobb角改善情况与术前比较，差异均有统计学意义（F_时间=3 025.591、7 257.375、5 638.076、1 548.607，均P<0.05）；两组椎体前缘高度及Cobb角改善情况在各对应时间点比较，差异均有统计学意义（F_组间=65.683、31.669，均P<0.05）；两组VAS评分、ODI在各对应时间点比较，差异均无统计学意义（F_组间=0.041、0.892，均P>0.05）。结论　新鲜组与陈旧组OVCF在PKP术后均取得较好的临床疗效，在术后1年相邻椎体骨折、改善椎体前缘高度及Cobb角方面，新鲜组优于陈旧组，但骨水泥渗漏率高于陈旧组。

Percutaneous kyphoplasty in treatment of fresh and old osteoporoticvertebral compression fractures

Objective　To investigate the clinical efficacies of percutaneous kyphoplasty (PKP)in the treatment of fresh and old osteoporotic vertebral compression fractures(OVCF). Methods　The 143 vertebralbodies of 104 OVCF patients treated by PKP from June 2019 to January 2021 inDepartment of Spine Surgery, Binzhou Medical University Hospital were selected.The patients were divided into an old group and a fresh group according to thecourse of disease and T₁ and T₂ signal intensities ofMRI. In the fresh group, there were 62 patients with 71 vertebral bodies,including 11 males and 51 females, with an age of (70.21±8.05). There were 42cases with 72 vertebral bodies in the old group, including 4 males and 38females, with an age of (70.05±5.17). All the patients underwent surgery underG-arm fluoroscopy. The perioperative related indicators, the heights of the anterioredge of the vertebral body, the Cobb angles of the sagittal kyphosis, theVisual Analog Scale (VAS) scores, the Oswestry disability indexes (ODI), andthe related complications in the two groups were recorded. The measurement datawere compared between the two groups by independent-sample t test, and the enumeration data by χ² test. Results　The operation was successfully completed in allthe patients. Ten cases of bone cement leakage occurred in the two groups;there were 9 cases in the fresh group, including 4 cases of intervertebralleakage and 5 cases of paravertebral leakage; in the old group, there was 1case of intervertebral leakage. One year after the operation, there were 1 caseof adjacent vertebral body fractures in the fresh group and 5 cases in the oldgroup, with a statistical difference (χ²=4.878, P<0.05); the height compressionrange of the anterior edge of the vertebral body was less than 10% in bothgroups, which was cured by conservative treatment. The operation time in thefresh group was shorter than that in the old group [(44.24±17.32) min vs.(56.12±30.05) min; t=-2.552, P<0.05]. The amount of bone cementinjected into a single vertebral body in the fresh group was more than that inthe old group [(3.90±1.07) ml vs. (3.53±0.90) ml], with a statisticaldifference (t =2.262, P<0.05). The VAS score, ODI, anteriorvertebral height, and Cobb angle of the two groups after the operation werestatistically different from those before the operation (F_time=3 025.591, 7 257.375, 5 638.076, and 1 548.607;all P<0.05); there werestatistical differences in the improvement of anterior vertebral body heightand Cobb angle between the two groups at each corresponding time point (F_{between groups}=65.683 and31.669; both P<0.05); there wereno statistical differences in the VAS score and ODI between the two groups ateach corresponding time point (F_{betweengroups}= 0.041 and 0.892; both P>0.05). Conclusions　Both the fresh groupand the old group achieved good clinical effects after PKP. The fresh group wasbetter than the old group in terms of adjacent vertebral body fractures,improving the height of anterior edge of vertebral body and Cobb angle one yearafter PKP, but the leakage rate of bone cement in the fresh group was higherthan that in the old group.