改良经皮球囊扩张椎体后凸成形术治疗骨质疏松性胸腰椎骨折的疗效

摘要

目的 比较经皮球囊扩张椎体后凸成形术(PKP)和改良经皮球囊扩张椎体后凸成形术(IPKP)治疗老年骨质疏松性椎体压缩性骨折(OVCF)的疗效. 方法 回顾性分析2009年9月-2014年9月收治的103例老年OVCF患者,根据手术方法分为IPKP组(57例,72椎)和PKP组(46例,58椎).比较两组患者术前骨折椎体压缩度、术后椎体高度恢复率、术后末次随访椎体高度丢失率、骨水泥渗漏发生率、相邻椎体再骨折发生率及术前术后视觉模拟评分(VAS)和功能障碍指数(ODI). 结果 患者术后均获随访6～38个月(平均16个月),两组术前骨折椎体压缩度、术后椎体高度恢复率、术后末次随访椎体高度丢失率比较,差异均无统计学意义(P＞0.05).PKP组和IPKP组骨水泥渗漏率分别为14％和8％(P＞0.05),椎体骨折再发生率分别为20％和5％(P＜0.05).两组术前、术后、末次随访时VAS与ODI比较,差异均无统计学意义(p＞0.05).两组内术前与术后、术前与末次随访时VAS、ODI比较,差异均有统计学意义(P＜0.05).术后与末次随访VAS、ODI比较,差异均无统计学意义(P＞0.05). 结论 PKP和IPKP治疗OVCF均可恢复椎体高度,缓解患者疼痛和提高活动功能.但IPKP的术后远期椎体高度再丢失率较小,椎体再骨折发生率低.%Objective To compare the curative effect of improved percutaneous kyphoplasty (IPKP) with conventional PKP in the treatment of osteoporotic vertebral compression fracture (OVCF).Methods A retrospective analysis was made on 103 senile patients with OVCF undergone IPKP (57 cases,72 vertebras) or PKP (46 cases,58 vertebras) between September 2009 and September 2014.Preoperative vertebral compression,vertebral height restoration,height loss,bone cement leakage and adjacent vertebral refracture were compared between the two groups.Curative effect was evaluated using the visual analogue score (VAS) and Oswestry disability index (ODI).Results Duration of follow-up was 6-38 months (mean,16 months).Between-group differences were insignificant with respect to the rate of preoperative vertebral compression,rate of postoperative height restoration and height loss rate at the final follow-up (P ＞ 0.05).PKP versus IPKP was associated with a higher rate of cement leakage (14％ vs.8％) (P＞0.05) and refracture (20％ vs.5％) (P＜0.05).VAS and ODI between the two groups did not differ significantly before and after operation and at the final follow-up (P ＞ 0.05).VAS and ODI within the group showed significant differences after operation and at the final follow-up compared to these before operation (P ＜ 0.05),but there were no significant differences after operation and at the final follow-up (P ＞ 0.05).Conclusions Both procedures can restore vertebral height,alleviate pain and improve mobility.By contrast,IPKP provides long-term benefits in vertebral height loss and refracture rate.