摘要
目的探讨经皮椎体后凸成形术(PKP)对骨密度正常、骨密度下降和骨质疏松性胸腰椎压缩性骨折的临床疗效。方法回顾性分析2016年6月—2017年1月采用PKP治疗的72例胸腰椎压缩性骨折患者的临床资料。根据术前患者腰椎平均骨密度T值,将患者分为骨密度正常组(T值>-1,A组),骨密度下降组(-1≥T值≥-2.5,B组)和骨质疏松组(T值<-2.5,C组)。采用疼痛视觉模拟量表(VAS)评分评价各组患者术前术后疼痛程度。以正侧位X线片为基础,以压缩椎体的楔形角表示椎体的几何学形状;以包含伤椎上下2个椎体的三节段后凸角评价脊柱后凸畸形程度。记录并比较各组术后骨水泥渗漏的发生率。结果所有患者术后VAS评分、楔形角和后凸角均较术前明显改善,差异均有统计学意义(P <0.05)。C组VAS评分及楔形角改善程度显著优于A和B组,差异均有统计学意义(P <0.05),但A、B组间相比差异无统计学意义(P> 0.05)。3组间后凸角改变程度差异均无统计学意义(P> 0.05)。A、B和C组的骨水泥渗漏率分别为12.5%(2/16)、7.4%(2/27)和17.2%(5/29),3组间差异无统计学意义(P> 0.05)。结论对于不同骨密度胸腰椎压缩性骨折患者,PKP均能显著缓解其腰背痛,并能不同程度地纠正压缩椎体的几何学畸形,且对骨质疏松性椎体压缩性骨折临床疗效更好。
Objective To investigate the efficacy of percutaneous kyphoplasty（PKP） for thoracolumbar vertebral compression fractures with normal bone mineral density,decreased bone mineral density or osteoporosis. Methods The clinical data of 72 cases of thoracolumbar vertebral compression fractures treated by PKP from June 2016 to January 2017 were retrospectively analyzed. According to the mean bone mineral density（T value） of the patients before operation,the patients were divided into normal bone mineral density group（T value 〉 -1,group A）,decreased bone mineral density group（-1 ≥ T value ≥ -2.5,group B） and osteoporosis group（T 〈 -2.5,group C）. Pain visual analogue scale（VAS） was used to evaluate the pain severity before and after operation. Based on the anteroposterior and lateral roentgenographs,the geometric shape of the vertebral body was represented by the wedge angle of the compressed vertebrae;the kyphosis deformity was evaluated by three-segmental kyphotic angle containing upper and lower vertebrae. The incidence of postoperative cement leakage was recorded and compared between different groups. Results The VAS score,wedge angle and kyphosis angle of all the patients were significantly improved compared with those before operation,and the differences were statistically significant（P〈0.05）. The improvement of VAS score and wedge angle in group C was significantly better than that of groups A and B,and the differences were statistically significant（P〈0.05）,but there was no statistical difference between groups A and B（P〉0.05）. There was no significant difference in the improvement of kyphotic angle between the 3 groups（P〉0.05）. The leakage rates of bone cement in groups A,B and C were 12.5%（2/16）,7.4%（2/27） and 17.2%（5/29）,respectively,and there was no significant difference between the 3 groups（P〉0.05）. Conclusion PKP is effective for relieving the low back pain and correcting geometric deformity in thoracolumbar vertebral compression fractures with any bone mineral density. In addition,thoracolumbar vertebral compression fractures combined with osteoporosis have more chance to acquire more benefit from PKP.
作者
葛晨
陈哲
郑月焕
曹鹏
GE Chen;CHEN Zhe;ZHENG Yue-huan;CAO Peng(Department of Orthopaedics,Ruijin Hospital North,Shanghai Jiao Tong University School of Medicine,Shanghai 201801,China;Department of Orthopaedics,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)
出处
《脊柱外科杂志》
2018年第5期272-275,共4页
Journal of Spinal Surgery
关键词
胸椎
腰椎
骨密度
脊柱骨折
骨折
压缩性
椎体后凸成形术
Thoracic vertebrae Lumbar vertebrae Bone density Spinal fractures Fractures
compression Kyphoplasty
