网袋加压成形与后凸成形治疗后壁破损型骨质疏松性椎体压缩性骨折的近期疗效对比

Objective To investigate the short-term efficacy of vesselplasty and percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fractures (OVCF) with posterior wall damage. Methods A total of 42 patients who underwent vesselplasty or PKP for OVCF with posterior wall damage in our hospital from January 2014 to August 2017 were included, with 15 cases in the former group and 27 cases in the latter group. The leakage of bone cement was observed, and the Visual Analogue Scale (VAS) of pain, Oswestry disability index (ODI), Cobb angle of the injured vertebra, and the heights of the anterior, middle, and posterior edges of the vertebral body were recorded before and on the first day after surgery. Results The leakage rate of bone cement in the vesselplasty group was 57.1% (8/14), including 6 cases of non-posterior wall leakage and 2 cases of posterior wall leakage; the leakage rate of bone cement in the PKP group was 65.4% (17/26), including 12 cases of non-posterior wall leakage and 5 cases of posterior wall leakage. There was no significant difference in the leakage rate of bone cement between the two groups (χ² = 0.264, P = 0.608). On the first day after surgery, the VAS scores and ODI in both groups were significantly improved compared with those before surgery, the Cobb angles were significantly decreased compared with those before surgery, and the heights of the anterior, middle, and posterior edges of the injured vertebra were significantly increased compared with those before surgery. The differences within the groups before and after surgery were significant (P < 0.05). Conclusions For OVCF with posterior wall damage, treatment with vesselplasty or PKP can significantly improve the relief of thoracolumbar pain, the improvement of quality of life, the restoration of the Cobb angle and height of the injured vertebra compared with those before surgery, but there is no significant difference between the two. There is also no significant difference in the leakage rate of bone cement between the two, and the clinical safety is similar.

目的探讨网袋加压椎体成形术(vesselplasty)与经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗后壁破损型骨质疏松性椎体压缩性骨折(osteoporotic vertebral compression fracture,OVCF)的近期疗效。方法纳入2014年1月~ 2017年8月因后壁破损型OVCF于我院行vesselplasty或PKP的42例,其中前者15例,后者27例,观察骨水泥渗漏情况,记录术前及术后第1天疼痛视觉模拟评分(Visual Analogue Scale,VAS) 、Oswestry功能障碍指数(Oswestry disability index, ODI) 、伤椎Cobb角、椎体前中后缘高度。结果vesselplasty组骨水泥渗漏率57. 1%(8 /14) ,其中6例非椎体后壁渗漏,2例后壁渗漏; PKP组骨水泥渗漏率65. 4 %(17 /26) ,其中12例非后壁渗漏,5例后壁渗漏。2组骨水泥渗漏率差异无显著性(χ~2 = 0. 264,P = 0. 608) 。2组术后第1天VAS评分、ODI较术前均明显改善,Cobb角较术前均明显减小,伤椎前、中、后缘高度比较术前均明显增加,组内手术前后差异有显著性(P 0. 05) 。结论对存在后壁破损的OVCF,以vesselplasty或PKP治疗,在缓解胸腰椎疼痛、提高生活质量、恢复伤椎Cobb角及伤椎高度上均较术前有明显改善,但两者间并无明显差异。两者在骨水泥渗漏率上亦无明显差异,临床安全性相似。