摘要
目的微创治疗骨科疾病是未来医学发展的方向。文中旨在观察手法复位结合经皮椎体后凸成形术(percutaneouskyphoplasty,PKP)治疗老年新鲜骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)的疗效。方法收集2011年6月至2014年3月的OVCF患者60例,随机分为2组:观察组(采用手法复位+PKP治疗,n=30)和对照组(单用PKP治疗,n=30)。分别记录2组手术时间、骨水泥注射量、后凸Cobb角改变、椎体前缘高度的恢复情况、术前及术后3 d、3个月的临床疼痛视觉模拟评分(visual analoguescale,VAS)、Oswestry功能障碍指数,比较组内及组间术前与术后各观察指标的差异。结果 60例患者均成功完成手术,观察组手术时间平均61 min,椎体骨水泥注射量平均5.1 m L,骨水泥分布良好,骨水泥泄漏1例,未引起明显不良后果;与术前比较,术后3 d椎体高度增加、后凸Cobb角下降、VAS评分降低、Oswestry功能障碍指数评分降低,差异均有统计学意义(P<0.05)。对照组手术时间平均46 min,椎体骨水泥注射量平均4.2 m L,骨水泥分布良好,骨水泥泄漏5例,未引起明显不良后果;与术前比较,术后3 d椎体高度增加、后凸Cobb角下降、VAS评分降低、Oswestry功能障碍指数评分降低,差异均有统计学意义(P<0.05)。与对照组比较,观察组术后3 d、3个月椎体高度升高[(22.4±1.4)mm vs(26.8±8.1)mm、(21.4±4.2)mm vs(26.5±7.2)mm],后凸Cobb角降低[(8.6±2.7)°vs(8.1±2.1)°、(9.0±2.3)°vs(8.3±1.8)°];术后3 d VAS评分下降[(4.1±2.2)分vs(3.1±2.0)分],Oswestry功能障碍指数评分升高[(23.0±3.1)分vs(25.6±3.3)分],差异均有统计学意义(P<0.05)。结论与单纯PKP比较,手法复位+PKP术治疗OVCF可以更好地缓解疼痛,恢复伤椎高度,且骨水泥泄漏比例少。
Objective Minimally invasive treatment of orthopedic diseases is the general direction of future development of medicine.This study was designed to observe the effect of manual reduction combined with percutaneous kyphoplasty （MR＋PKP） in the treatment of fresh osteoporotic vertebral compression fractures （ OVCF） in elderly patients. Methods Sixty OVCF patients aged 60-86 （ mean 72.3） years were randomly assigned to 2 groups of e-qual number to be treated by MR＋PKP and PKP alone, respectively. Comparisons were made between the two groups of patients in the op-eration time, volumeand permeability of the bone cement injected,changes of the Cobb angle,restoration of the anterior height of the compressed vertebral bodies,pre-and post-operative Visual Analogue Scale （ VAS） pain scores, OswestryDisability Indexes （ ODIs） , and other differences observed before and aftersurgery. Results Op-erations were performed successfully in all the 60 cases.In the MR＋PKP group, the mean operation time was 61 min, the mean volume of bone cement injected was 5.1mL with qualified distribution, and bone cement leakage occurred in 1 case without adverse reaction. Statistically significant differences were found in the pre-and post-operativeanterior height of the compressed vertebral bodies, Cobb an-gle, VAS scores, and ODIs （P30.05）.Compared with the PKP control, MR＋PKP achieved a significant increase at 3 days and 3 months after surgery in the anterior height of the compressed vertebral bodies （[22.4±1.4] vs [26.8±8.1] mm and [21.4±4.2] vs [26.5±7.2]mm, P30.05）, and a decrease in the Cobb angle （[8.6±2.7] vs [8.1±2.1]°and [9.0±2.3] vs [8.3±1.8]°76;, P30.05） as well as remarkably reduced VAS scores （4.1±2.2vs 3.1±2.0, P30.05）and ODIs （23.0±3.1vs25.6±3.3, P30.05） at 3 d postopera-tively. Conclusion MR＋PKP, with its advantages of effective pain-relief, improvement of the height of compressed vertebral bodies, and reduction of bone cement leakage,is better than PKP alone for the treatment of OVCF in elderly patients.
出处
《医学研究生学报》
CAS
北大核心
2015年第4期385-389,共5页
Journal of Medical Postgraduates
基金
国家自然科学基金(81401611)
关键词
手法复位
椎体成形
椎体压缩
Manual Reduction
Vertebral Plasty
Vertebral Compression
