目的:探讨骨成形术联合经皮椎体成形术(PVP)和单纯经皮椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩性骨折(OVCFs)的临床疗效。
方法:回顾性分析2021年1月至2022年6月80例单级别OVCFs患者的临床资料,根据手术方式不同分为治疗组和对照组,每组40例。在治疗组中,有24名男性和16名女性,年龄60至83岁,平均(70.43±7.31)岁;骨密度范围为-3.30至-2.50SD,平均(-2.84±0.24)SD;T10患者1例,T11患者4例,T12患者11例,L1患者7例,L2患者7例,L3患者5例,L4患者3例,L5患者2例;进行骨固定技术联合PVP。在对照组中,有27名男性和13名女性,年龄60至82岁,平均(68.98±6.94)岁;骨密度范围为-3.40至-2.50SD,平均(-2.76±0.23)SD;T10患者2例,T11患者3例,T12患者13例,L1患者11例,L2患者5例,L3患者3例,L4患者2例,L5患者1例;形成单纯PKP。术前比较两组患者的视觉模拟评分(VAS)和腰椎Oswestry残疾指数(ODI)。3天,术后3和12个月。局部后凸角的变化,术前比较两组椎体楔角和椎体前缘高度比,术后3天和12个月。
结果:所有患者均顺利完成手术。治疗组随访13~22个月,平均(16.82±2.14)个月。对照组随访13~23个月,平均(16.45±2.56)个月。治疗组有3例患者发生骨水泥渗漏。对照组1例发生骨水泥渗漏,1例发生下肢皮肤感觉障碍,两组并发症比较差异无统计学意义(P>0.05)。两组术前VAS、ODI比较差异无统计学意义(P>0.05)。手术后3天,治疗组VAS评分3.68±0.62明显高于对照组4.00±0.72(P<0.05)。两组术后3、12个月VAS、ODI比较差异无统计学意义(P>0.05)。局部后凸角无显著差异,术后3天和12个月,两组椎体楔角和椎体前缘高度比较(P>0.05)。
结论:与PKP相比,正骨手法联合PVP治疗OVCFs在术后早期缓解疼痛方面具有优势。在椎体高度恢复方面,正骨手法联合PVP与单纯PKP具有相似的临床疗效。
OBJECTIVE: To explore clinical efficacy of osteoplasty combined with percutaneous vertebroplasty(PVP) and percutaneous kyphoplasty (PKP) alone in treating osteoporosis vertebral compression fractures (OVCFs).
METHODS: The clinical data of 80 patients with single-level OVCFs treated from January 2021 to June 2022 were retrospectively analyzed, and were divided into treatment group and control group according to different surgical methods, 40 patients in each group. In treatment group, there were 24 males and 16 females, aged from 60 to 83 years old with an average of (70.43±7.31) years old;bone mineral density ranged from -3.30 to -2.50 SD with an average of(-2.84±0.24) SD;1 patient with T10, 4 patients with T11, 11 patients with T12, 7 patients with L1, 7 patients with L2, 5 patients with L3, 3 patients with L4, 2 patients with L5;bone setting technique combined with PVP were performed. In control group, there were 27 males and 13 females, aged from 60 to 82 years old with an average of (68.98±6.94) years old;bone mineral density ranged from -3.40 to -2.50 SD with an average of (-2.76±0.23) SD;2 patients with T10, 3 patients with T11, 13 patients with T12, 11 patients with L1, 5 patients with L2, 3 patients with L3, 2 patients with L4, 1 patient with L5;simple PKP were peformed. Visual analogue scale (VAS) and lumbar Oswestry disability index (ODI) were compared between two groups before operation, 3 days, 3 and 12 months after operation. The changes of local kyphotic angle, vertebral wedge angle and vertebral anterior margin height ratio were compared between two groups before operation, 3 days and 12 months after operation.
RESULTS: All patients were successfully completed operation. Treatment group were followed up from 13 to 22 months with an average of (16.82±2.14) months, and control group were followed up from 13 to 23 months with an average of (16.45±2.56) months. Three patients were occurred bone cement leakage in treatment group, while 1 patient were occurred bone cement leakage and 1 patient occurred sensory disturbance of lower limb skin in control group;there were no significant difference in complications between two groups (P>0.05). There were no significant difference in preoperative VAS and ODI between two groups (P>0.05). At 3 days after operation, VAS of treatment group 3.68±0.62 was significantly higher than that of control group 4.00±0.72 (P<0.05). There were no significant difference in VAS and ODI between two groups at 3 and 12 months after operation (P>0.05). There were no significant difference in local kyphotic angle, vertebral wedge angle and vertebral anterior margin height between two groups at 3 days and 12 months after operation (P>0.05).
CONCLUSIONS: Compared with PKP, bone setting manipulation combined with PVP for the treatment of OVCFs has advantages in early postoperative pain relief. In terms of vertebral height recovery, bone setting manipulation combined with PVP and PKP alone have similar clinical effects.