摘要
目的分析胸腰椎骨折患者行经皮椎体后凸成形术（PKP）治疗的近期疗效和再发骨折率及其与骨质疏松程度的相关性。方法回顾性分析2008年1月-2014年2月因胸腰椎椎体骨折接受PKP治疗的患者247例，其中男94例，女153例；年龄50～81岁，平均63．2岁。致伤原因：平地跌伤119例，交通伤72例，高处坠落伤56例。按术前骨密度检测值分为骨量减少组和严重骨质疏松组，分别在术前、术后3d、3个月、1，2，3年行视觉疼痛模拟评分（VAS）、Roland—Morris功能障碍调查量表（RDQ）评分，计算椎体高度压缩率和椎体后凸Cobb角及再发骨折情况，了解不同程度骨质疏松对疗效的影响。结果术后随访18～36个月，平均24．3个月。术后3d两组患者VAS分别由术前（7．7±2．1）分、（7．7±2．0）分降至（4．3±1．1）分、（4．2±1．5）分（P〈0．05）；RDQ评分分别由术前（21．2±1．5）分、（20．8±1．9）分降至（10．4±2．5）分、（11．2±1．7）分（P〈0．05）；椎体高度压缩率由术前（42．2±10．5）％、（46．2±12．7）％降至（3．2±0．5）％、（2．9±0．8）％（P〈0．05）；椎体后凸Cobb角由术前（21．2±9．5）°、（23．1±8．9）°降至（7．2±2．4）°、（7．1±2．6）°（P〈0．05）。术后3年两组VAS、RDQ评分、椎体高度压缩率及椎体后凸Cobb角仍优于术前，但严重骨质疏松组VAS、RDQ评分、椎体高度压缩率、椎体后凸Cobb角及再骨折发生率均较骨量减少组高（P〈0．05）。结论骨质疏松性胸腰椎椎体骨折经PKP治疗的近期疗效满意，但随着骨质疏松程度的加重，再发骨折率显著增加，需更重视对骨质疏松的针对性治疗。
Objective To examine the short-and middle-term efficacy and refracture rate in patients with thoracolumbar fracture having percutaneous kyphoplasty （PKP） and determine their correlation with the severity of osteoporosis. Methods A retrospective analysis was conducted on 247 patients with thoracolumbar fracture undergone PKP from January 2008 to February 2014. Mean age of the patients （94 males and 153 females） was 63.2 years （range, 50-81 years）. Ground-level falls occurred in 119 patients, traffic injuries in 72 patients and high falls in 56 patients. The patients were assigned to osteopenia group and osteoporosis group based on the preoperative bone mineral density. Visual analogue score （VAS）, Roland-Morris disability survey scale （RDQ）, vertebra] compression rate, kyphotic Cobb angle and refracture rate were recorded before and after operation. Efficacy in correlation with the severity of osteoporosis was evaluated. Results Mean duration of follow-up was 24.3 months （range, 18-36 months）. Three days after operation, VAS descended from （7.7 ± 2. 1 ） points to （4.3 ± 1. 1 ） points in osteopenia group and from （7.7 ± 2.0） points to （4.2 ± 1.5 ） points in osteoporosis group （ P 〈 0.05 ） ; RDQ descended from （21.2 ± 1.5 ） points to （ 10.4 ± 2.5 ） points in osteopenia group and from （ 20.8 ± 1.9 ） points to （ 11.2 ＋ 1.7 ） points in osteoporosis group （ P 〈 0.05 ） ; rate of vertebral body compression descended from （42.2 ± 10.5 ） % to （ 3.2 ± 0.5 ） % in osteopenia group and from （46.2 ± 12.7 ） % to （ 2.9 ± 0.8 ） % in osteoporosis group （ P 〈 0.05 ） ; kyphotic Cobb angle descended from （ 21.2 ± 9.5 ） °to （7.2 ± 2.4）° in osteopenia group and from （23.1 ± 8.9） ° to （7.1 ± 2.6）° in osteoporosis group （P 〈 0. 05 ）. Three years after operation, all the parameters remained better than these before operation, with the value higher in osteoporosis group than in osteopenia group （ P 〈 0.05 ）. Rate of refracture was higher in osteoporosis group after operation, compared to that in osteopenia group （P 〈 0.05）. Conclusions The clinical short-term result is satisfactory, but refracture rate is increased with the osteoporosis aggravation. Targeting osteoporosis therapy is important to obtain a better mid-term results.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2015年第12期1073-1076,共4页
Chinese Journal of Trauma
