背景:无神经症状的骨质疏松性椎体爆裂骨折(OVBF)的最佳治疗方法仍存在争议。
目的:评价经皮椎体后凸成形术(PKP)治疗OVBF的安全性和有效性。
方法:本研究为前瞻性研究,在中国临床试验注册中心注册,注册号为ChiCTR-OOC-17013227。
方法:本研究纳入119例137个椎骨骨折患者,这些患者接受单侧PKP治疗OVBF。
方法:由两名医生独立进行测量,并使用图片存档和通信系统(PACS)和ImageJ软件(美国国立卫生研究院,贝塞斯达,MD,美国)。
方法:通过三维计算机断层成像(CT)测量手术前后椎管面积和后壁突起(PWP)的变化。术前,术后,最后随访站立X射线用于测量前壁的高度(HAW),后壁高度(HPW),和局部后凸角(LKA)。此外,还确定了视觉模拟量表(VAS)和Oswestry残疾指数(ODI)。
结果:在评估的137个椎骨中,79显示术后运河面积增加,虽然57显示下降,平均值为8.28±6.871mm²和-9.04±5.991mm²,分别。值得注意的是,在整个数据集上没有发现术后管区的显著变化(p>0.01).术前中位数[3.9(IQ1-IQ3=3.3-4.8)mm]和术后[3.7(IQ1-IQ3=3.0-4.4)mm]PWP之间显着降低(p<0.01)。术前和术后HAW测量值分别为19.4±6.1mm和23.2±5.2mm,分别(p<0.01)。然而,在最后的后续行动中,HAW低于术后值。术后HPW也显著改善(p<0.01),但在最后的后续行动中,与术后测量相比,明显下降。手术后,KA被显著校正(p<0.01);然而,在最后的后续行动中,检测到复发(平均KA:18.4±10.3度)。在最后的后续行动中,VAS和ODI均较术前显著改善(p<0.01)。至于并发症,50例患者出现水泥渗漏,16例患者出现椎体再骨折。所有患者在随访期间均未出现神经系统症状。
结论:无神经功能缺损的OVBF显示PKP术后症状明显改善。椎管区无明显改变,但观察到PWP显著下降。因此,我们认为PKP是治疗无神经系统症状的OVBF病例的安全有效的手术干预措施.
BACKGROUND: The optimal treatment for osteoporotic vertebral burst fracture (OVBF) without neurological symptoms is still a matter of debate.
OBJECTIVE: To evaluate the safety and efficacy of percutaneous kyphoplasty (PKP) for OVBF.
METHODS: The study is a prospective study and is registered in the
China Clinical Trials Registry with the registration number ChiCTR-OOC-17013227.
METHODS: The study involved 119 patients with 137 fractured vertebrae who underwent unilateral PKP for OVBF.
METHODS: The measurements were carried out independently by two physicians and measured with picture archiving and communication system (PACS) and ImageJ software (National Institutes of Health, Bethesda, MD, USA).
METHODS: The change in the spinal canal area and posterior wall protrusions (PWP) were measured before and after surgery via three-dimensional computed tomographic imaging (CT). Preoperative, postoperative, and final follow-up standing X-rays were used to measure the height of the anterior wall (HAW), height of the posterior wall (HPW), and local kyphotic angle (LKA). Additionally, visual analogue scale (VAS) and the Oswestry Disability Index (ODI) were also determined.
RESULTS: Among the 137 vertebrae assessed, 79 exhibited an increased postoperative canal area, while 57 showed a decrease, with mean values of 8.28±6.871 mm² and -9.04±5.991 mm², respectively. Notably, no significant change in postoperative canal area was identified on the entire dataset (p>.01). There was a significant decrease between median preoperative (3.9 [IQ1-IQ3=3.3-4.8] mm) and postoperative (3.7 [IQ1-IQ3=3.0-4.4] mm) PWP (p<.01). Preoperative and postoperative HAW measurements were 19.4±6.1 mm and 23.2±5.2 mm, respectively (p<.01). However, at the final follow-up, the HAW was lower than the postoperative value. The HPW was also significantly improved after surgery (p<.01), but at the final follow-up, it was significantly decreased compared with the postoperative measurement. Following surgery, KA was significantly corrected (p<.01); however, at the final follow-up, relapse was detected (average KA: 18.4±10.3°). At the final follow-up, both VAS and ODI were significantly improved compared with the preoperative period (p<.01). As for complications, 50 patients experienced cement leakage, and 16 patients experienced vertebral refracture. All patients did not develop neurological symptoms during the follow-up.
CONCLUSIONS: OVBF without neurological deficits showed significant improvement in symptoms during the postoperative period after PKP. There was no notable alteration in the spinal canal area, but a significant decrease in PWP was observed. Consequently, we posit that PKP stands as a secure and efficacious surgical intervention for treating OVBF cases devoid of neurological symptoms.