椎体成形术及椎体后凸成形术对骨质疏松性压缩椎体骨折患者椎体几何学畸形的影响

摘要

目的：探讨椎体成形术及椎体后凸成形术对骨质疏松性压缩椎体骨折患者椎体几何学畸形的影响。方法将骨质疏松性椎体压缩骨折患者120例采用随机数字表法分为经皮椎体成形术(PVP)组和经皮椎体后凸成形术(PKP)组各60例,观察两组患者椎体高度恢复和止疼状况及椎体几何学形态变化情况。结果PVP 组手术正常形态及矫正率为18.3%,明显低于 PKP 组36.7%(P <0.05)；同时两组患者手术后椎体压缩后凸成角畸形方面均比治疗前有明显改善(P <0.05),其中 PKP 组明显优于 PVP 组(P <0.05)。 PVP 组手术后 VAS 评分(2.33±0.92)明显低于术前(7.76±0.99)(P <0.05)；PKP 组术后 VAS 评分(2.35±0.91)明显低于术前(8.01±0.89)(P <0.05)。同时两组患者术后椎体几何学畸形完全恢复正常态患者 VAS 评分为2.59±0.91,未完全恢复患者 VAS 评分为2.30±0.92,但无统计学意义(P >0.05)。结论对骨质疏松性压缩椎体骨折患者采用PVP、PKP 手术治疗,均能达到较好的止疼效果,促使患者部分伤椎体恢复正常；在椎体几何学畸形矫正方面,PKP明显优于 PVP,针对椎体严重畸形的患者,建议运用 PKP 来治疗。%Objective To discuss the effect of vertebroplasty and posterior vertebral body on vertebral body geometry of patients with osteoporotic vertebral compression fractures. Method 120 cases of patients osteoporotic vertebral com-pression fractures treated in our hospital from January 2012 to January 2014 were randomly divided into percutaneous verte-broplasty (PVP ) group and percutaneous kyphoplasty (PKP ) group,with 60 cases in each group,and they were respec-tively given percutaneous vertebroplasty and percutaneous kyphoplasty. Then the vertebral height restoration,pain conditions and vertebral geometry morphology of patients in the two groups were observed. Results The rate of correction in the PVP group was 18. 3% ,which was significantly lower than that of 36. 7% in the PKP group (P < 0. 05). Compressor verte-bral kyphosis deformities of the two groups after treatment were significantly improved than those before treatment (P <0. 05),of which the PKP group was better than that of the PVP group (P < 0. 05),and the VAS score in the PVP group be-fore operation was 7. 76 ± 0. 99,which was 2. 33 ± 0. 92 after operation,and the difference was statistically significant (t =31. 122,P = 0. 000). The VAS score in the PKP group before operation was 8. 01 ± 0. 89,which was 2. 35 ± 0. 91 after oper-ation,and the difference was statistically significant (t = 36. 859,P = 0. 000). The VAS score of patients with vertebral body geometry deformity after complete recovery of normal state in the two groups was 2. 59 ± 0. 91,which was 2. 30 ± 0. 92 in the patients without vertebral body geometry deformity after complete recovery of normal state,and the difference was not statisti-cally significant (t = 1. 736,P = 0. 085 ). Conclusion Osteoporotic vertebral compression fractures treated with PVP and PKP surgery can make the better results for the pain,and help injury vertebral return to normal. In terms of vertebral de-formity geometry,PKP is significantly better than PVP,so for patients with severe vertebral deformity,it is recommended to use PKP.