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不同手术方法治疗骨质疏松性椎体压缩性骨折
张晓星,代灿,邓志龙,苟景跃
0
重庆市第四人民医院脊柱外科(重庆 400014)
摘要:
了解骨质疏松性椎体压缩性骨折(OVCF)早期进行经皮椎体成形术(PVP),或经皮椎体后凸成形术(PKP)围手术期指标和疗效的差异。方法:回顾性分析86例骨质疏松性椎体压缩骨折患者,其中PVP组52例、PKP组34例。比较两组围手术期指标(手术时间、骨水泥注入总量、术后伤椎增加高度、术后VAS评分)和随访指标(椎体前缘高度、后凸Cobb角、椎体压缩率)的统计学差异。结果:PVP组(27.7±6.0)手术时间短于PKP组(37.3±8.1);PVP组(4.6±1.4)骨水泥注入总量小于PKP组(6.0±2.7),PVP组(2.6±1.5)术后伤椎增加高度小于PKP组(9.0±2.0),PVP组(2.4±0.4)术后VAS评分小于PKP组(1.9±0.2),差异均有统计学意义(P<0.05)。两组患者术后比较,PVP组(19.85±2.16)椎体前缘高度低于PKP组(24.18±3.07),PVP组(12.43±2.08)后凸Cobb角大于PKP组(8.01±3.45),PVP组(24.89±5.52)椎体压缩率大于PKP组(20.23±3.49)差异均有统计学意义(P<0.05)。术前术后比较,两组患者椎体前缘高度均显著增加、后凸Cobb角和椎体压缩率均显著降低(P<0.05)。结论:PKP相比PKP能进一步改善OVCF病椎的裂隙修复,尽可能恢复椎体高度,术后疼痛程度轻;但手术时间较长,骨水泥注入量相对较多,且不适用于重度压缩骨折。
关键词:  骨质疏松  椎体压缩性骨折  经皮椎体成形术  经皮椎体后凸成形术
DOI:10.3969/j.issn.1007-6948.2019.01.005
基金项目:
Different Surgical Methods Were Used to Treat Osteoporotic Vertebral Compression Fractures
ZHANG Xiao-xing,DAI Can,DENG Zhi-long,GOU Jingyue
Department of Spine Surgery, Chongqing Fourth People' s Hospital,Chongqing(400014), China
Abstract:
objective To investigate the differences of percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) during the perioperative period of osteoporotic vertebral compression fracture (OVCF). Methods Eighty-six cases of osteoporotic vertebral compression fractures were retrospectively analyzed, including 52 cases in the PVP group and 34 cases in the PKP group. The perioperative indexes (operation time, total amount of bone cement injection, postoperative vertebral growth height, postoperative VAS score) and follow-up indexes (vertebral anterior margin height, kyphoid Cobb Angle, vertebral compression rate) of the two groups were compared statistically. Result The operative time of PVP group was shorter than PKP group (37.3±8.1). The total amount of bone cement injected into the PVP group was less than PKP group (27.7±6.0), the height of postoperative vertebral injury increase in the PVP group(2.6±1.5) was less than PKP group(9.0±2.0), and the postoperative VAS score in the PVP group(2.4±0.4)was less than PKP group(1.9±0.2), with statistically significant differences (P<0.05). Postoperative comparison of the two groups of patients showed that the height of the anterior margin of the PVP group (19.85±2.16) was lower than that of the PKP group(24.18±3.07), the Cobb Angle of the posterior lobe of the PVP group (12.43±2.08) was greater than that of the PKP group(8.01±3.45), and the compression rate of the PVP group(24.89±5.52) was higher than that of the PKP group (20.23±3.49). Preoperative and postoperative comparison showed that the height of the anterior margin of the vertebral body was significantly increased, the Cobb Angle of the kyphoid and the compression rate of the vertebral body were significantly reduced in both groups (P<0.05). Conclusions PKP, compared with PKP, can further improve fracture repair of diseased OVCF vertebra, restore vertebral height as far as possible, and relieve postoperative pain. However, the operation time is long, the amount of bone cement injection is relatively large, and is not suitable for severe compression fracture.
Key words:  Osteoporosis  vertebral compression fracture  percutaneous vertebroplasty  percutaneous kyphoplasty

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