急性期与非急性期骨质疏松性胸腰椎骨折行经皮椎体成形术疗效对比分析

Comparison of efficacy of percutaneous vertebroplasty for acute and non-acute osteoporotic vertebral compression fractures

关键词:  胸椎  腰椎  骨折  骨质疏松  椎体成形术

Key words:  thoracic vertebrae  lumbar vertebrae  fractures  osteoporosis  vertebroplasty

摘要:

目的比较急性期与非急性期骨质疏松性胸腰椎骨折（osteoporotic vertebral compression fractures, OVCF）行经皮椎体成形术（percutaneous vertebroplasty PVP）的临床疗效差异。 方法回顾性分析2021年1月—12月行PVP手术治疗的骨质疏松性胸腰椎性骨折患者的临床数据资料，根据患者发生骨折到接受手术治疗的时间长短分为急性期组（≤2周，80例）和非急性期组（>2周，56例）。记录两组患者手术时骨水泥注射量，骨水泥弥散分布是否满意以及骨水泥渗漏发生率，比较两组患者手术前后伤椎椎体压缩比（前缘及中部），伤椎Cobb角、疼痛视觉模拟评分（visual analog score, VAS）及Oswestry功能障碍指数（oswestry disability index, ODI）变化。 结果两组患者均顺利完成手术，随访时间为（15.92±2.78）个月（12~21个月），无脊髓神经损伤等并发症发生。2组患者术后椎体高度恢复（前缘及中部）、Cobb角、VAS评分及ODI评分，较术前均有明显恢复（P<0.05），急性期组患者骨水泥注入量、骨水泥弥散分布、椎体高度恢复、Cobb角改善及随访时椎体高度和Cobb角维持优于非急性期组患者（P<0.05），末次随访时急性期组患者疼痛缓解（VAS评分）和功能恢复（ODI评分）也优于非急性期组患者（P<0.05），术后即刻疼痛缓解（术后3d VAS）和骨水泥渗漏发生率两组患者对比，差异无统计学意义（P>0.05）。 结论骨质疏松性胸腰椎骨折患者早期采用椎体成形手术治疗可以有效恢复和维持椎体高度，减轻患者疼痛，提高患者生活质量。

Abstract:

ObjectiveTo compare the clinical efficacy of percutaneous vertebroplasty(PVP) for acute and non-acute osteoporotic vertebral compression fractures(OVCF). MethodsThe clinical data of 136 patients with osteoporotic thoracolumbar vertebral compression fractures who underwent PVP from January 2021 to December 2021 were retrospectively analyzed, including 80 cases of acute phase(≤2 weeks) and 56 cases of non-acute phase(>2 weeks). Patients were followed up for (15.92±2.78) months(12-21 months). The amount of cement injected, the diffusion and distribution of bone cement, and the cement leakage were recorded in the two groups. The compression ratio of the injured vertebral body(anterior and middle), Cobb angle of the injured vertebral body, visual analogue pain score and Oswestry Disability Index(ODI) were compared between the two groups before and after surgery. ResultsBoth groups successfully completed surgery without spinal nerve injury and other complications. The postoperative recovery of vertebral body height(anterior and middle), Cobb angle, VAS score and ODI score were significantly improved after surgery in both groups(P<0.05). The amount of cement injected, the diffusion and distribution of cement, the recovery of vertebral body height, the visual analogue pain score(VAS) and the change in Oswestry Disability Index(ODI) in the acute group were significantly better than those in non-acute group(P<0.05). The distribution, recovery of vertebral height, improvement of Cobb angle and maintenance of vertebral height and Cobb angle at follow-up in the acute phase group were better than those in the non-acute phase group(P<0.05). The VAS score and ODI score in the acute phase group at final follow-up were also better than those in the non-acute phase group(P<0.05). There were no significant differences in the VAS at 3 d after surgery and bone cement leakage between the two groups(P>0.05). ConclusionEarly treatment of osteoporotic thoracolumbar vertebral fracture patients with vertebroplasty can effectively restore and maintain vertebral height, reduce pain, and improve the quality of life of patients.