摘要
目的探讨经皮椎体后凸成形术（perccutaneous kyphoplasty,PKP）治疗骨质疏松性椎体压缩骨折的（osteoporotic vertebral compression fractures,OVCFs）中期临床疗效分析。方法回顾分析自2008年1月至2011年12月行PKP治疗的163例OVCFs患者。比较患者术前、术后1周、术后1年、术后2年伤椎Cobb角变化、伤椎椎体平均高度变化、患者VAS评分、ODI指数变化,统计其术前、术后1周、术后1年、术后2年临床疗效、影像学评估及术后骨水泥渗漏、术后神经根、脊髓损伤及相邻椎体再骨折等并发症。结果本组术后随访2~4年,平均3年。所有病例均成功实施PKP治疗,无神经根损伤并发症,骨水泥渗漏5例,渗漏率2.60%。无骨水泥渗漏引起的临床症状。术前均采用GE公司生产的双能X线骨密度仪测定腰椎和髋部骨密度;术前椎体前缘高度平均为（18.42±0.73）mm,术后1周椎体前缘高度平均为（25.01±1.34）mm,术后1年椎体前缘高度为（24.23±1.09）mm,术后2年椎体前缘高度为（22.12±0.65）mm;术前伤椎Cobb角平均（25.65±1.74）°,术后1周伤椎Cobb角平均（17.49±1.58）°,术后1年伤椎Cobb角平均（17.90±1.18）°,术后2年伤椎Cobb角平均（18.70±1.12）°。术前VAS评分平均为（8.12±0.30）分,术后1周VAS评分平均为（2.54±0.21）分,术后1年VAS评分平均为（2.31±0.19）分,术后2年VAS评分平均（3.02±0.54）分。术前患者ODI平均（48.16±9.50）%,术后1周ODI平均（22.48±4.87）%,术后1年ODI平均（22.73±4.68）%,术后2年ODI平均（23.65±3.49）%。术前分别于与术后1周、术后1年、术后2年的VAS评分、ODI指数比较,P〈0.001,差异有统计学意义;术前分别与术后1周、术后1年、术后2年的Cobb角、椎体高度比较,P〈0.001,差异有统计学意义;在随访期间,术后1年后出现非相邻节段椎体骨折8例,3年后出现相邻节段椎体骨折13例,相邻节段骨折发生率占7.98%。结论 PKP治疗OVCFs有效恢复压缩椎体高度,纠正脊柱局部后凸畸形,迅速减轻或缓解患者疼痛,快速恢复患者下地活动能力,避免长期卧床引起的并发症,明显提高患者生活质量,发生相邻椎体骨折及渗漏率低,中期临床疗效可靠。
Objective To explore interim clinical efficacy of percutaneous kyphoplasty（ percutaneous kyphoplasty,PKP）on the treatment of osteoporotic vertebral compression fractures（ osteoporotic vertebral compression fractures,OVCFs）. Methods In this retrospective study,postoperative follow-ups were conducted on 163 patients between January 2008 and April2014,over a period of 2 ~ 4 years,at an average of 3 years. The change in Cobb angle,average change in vertebral height,as well as changes in VAS score and ODI index before surgery,1 week after surgery,1 year after surgery and 2 years after surgery,respectively,were compared. Clinical efficacy,medical imaging assessment,postoperative leakage of bone cement,injury of the nerve root and spinal cord,and adjacent vertebral fractures were statistically analyzed before surgery,1 week after surgery,1 year after surgery,and 2 years after surgery. Results PKP was conducted successfully in all cases,without nervous root injury complications,Cement leakage in 5 cases,leakage rate 2. 60%,no bone cement leakage caused clinical symptoms. Preoperative GE produced using dual-energy X-ray absorptiometry lumbar spine and hip bone mineral density was measured. The averagevertebral body height was found to be（ 1 8. 4 2 ± 0. 7 3） mm before surgery,（ 2 5. 0 1 ± 1. 3 4） mm 1 week after surgery,（ 24. 23 ± 1. 09） mm 1 year after surgery,and（ 22. 12 ± 0. 65） mm 2 years after surgery. Cobb angle was（ 25. 65 ± 1. 74） ° before surgery,（ 17. 49 ± 1. 58） ° 1 week after surgery,（ 17. 90 ± 1. 18） ° 1 year after surgery,and（ 18. 70 ± 1. 12） ° 2 years after surgery. VAS score was（ 8. 12 ± 0. 30） before surgery,（ 2. 54 ± 0. 21） 1 week after surgery,2. 31 ± 0. 19 1 year after surgery and 3. 02 ± 0. 54 2 years after surgery. ODI was 48. 16 ± 9. 50（ ODI%） before surgery,（ 22. 48 ± 4. 87） % 1 week after surgery,22. 73 ± 4. 68（ %） 1 year after surgery,and（ 23. 65 ± 3. 49） % 2 years after surgery. The VAS score and ODI were both found to be statistically significant（ P〈0. 001） when compared each preoperative score to their respective postoperative scores,specifically 1 week after surgery,1 year after surgery,and 2 years after surgery. A significant difference of P〈0. 001 was also found when comparing preoperative Cobb angle to 1-week postoperative,1-year postoperative and 2-year postoperative Cobb angle,as well as the preoperative vertebral height compared to 1-week postoperative,1-year postoperative and 3-year postoperative vertebral height. No patient experienced nervous system injury. Over the course of postoperative follow-up,there were 8 cases of non-adjacent vertebral fracture within 1 year,and 13 cases of adjacent vertebral fractures within 3 years,with the incidence rate of adjacent vertebral fractures of 7. 98%. Conclusion PKP is effective in the restoration of compressed vertebral height,correction of spinal kyphosis,and quick alleviation of pain in OVCF patients. It enables rapid recovery in patients and prevents long-term complications,which serves to improve the quality of life. The overall occurrence of adjacent vertebral fracture and leakage rate is low and interim clinical efficacy is reliable.
出处
《实用骨科杂志》
2015年第2期105-109,共5页
Journal of Practical Orthopaedics
