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骨填充网袋椎体成形术与经皮椎体后凸成形术治疗老年骨质疏松性椎体压缩骨折的疗效比较

Comparison on vesselplasty and percutaneous kyphoplasty in treatment of osteoporotic thoracolumbar vertebral fractures in elderly patients

摘要:

目的 比较骨填充网袋椎体成形术与经皮椎体后凸成形术治疗老年骨质疏松性椎体压缩骨折(OVCFs)的临床疗效. 方法 采用回顾性病例对照研究分析2013年8月-2015年5月收治的52例OVCFs患者的临床资料.根据治疗方式分为骨填充网袋椎体成形术治疗组(A组)和经皮椎体后凸成形术治疗组(B组).A组25例(38个椎体),其中男11例,女14例;年龄60 ~89岁[(63.6±8.3)岁].椎体分布:T119例,T12 10例,L113例,L2 6例.B组27例(41个椎体),其中男10例,女17例;年龄63~87岁[(64.1±9.6)岁].椎体分布:T117例,T12 13例,L112例,L29例.比较两组手术时间、透视次数、视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)变化、伤椎前缘高度、后凸Cobb角及骨水泥渗漏情况. 结果 患者均获随访6~18个月,平均12个月.A组手术时间为(29.3 ±4.1)min,B组为(35.7±5.2)min(P <0.05).A组透视次数为(9.3±1.5)次,B组为(13.1±3.7)次(P<0.05).A组和B组末次随访时,VAS分别为(1.3±0.3)分、(1.4±0.3)分,ODI分别为32.5 ±6.7、30.5 ±5.3,术后伤椎前缘高度分别为(85.3±9.7)%、(82.7±10.4)%,后凸Cobb角分别为(11.3±5.3).、(12.7±6.1).,均较术前显著改善(P<0.05),但组间比较差异无统计学意义(P>0.05).A组渗漏率为3%,B组为26%(P<0.05). 结论骨填充网袋椎体成形术和经皮椎体后凸成形术均可快速止痛,有效恢复伤椎高度;但骨填充网袋椎体成形术具有手术时间短、透视次数少、能更有效降低骨水泥渗漏等优势,是治疗老年OVCFs的有效方法.

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Objective To compare the clinical effects of vesselplasty and percutaneous kyphoplasty in the treatment of osteoporotic thoracolumbar vertebral fracture in the elderly.Methods A retrospective case control study was conducted to analyze 52 cases of OVCFs treated from August 2013 to May 2015.According to treatment method,the patients were assigned to vesselplasty (Group A) and percutaneous kyphoplasty (Group B).Group A (25 cases,38 vertebrae) included 11 males and 14 females,aged (63.6 ±8.3)years (range,60-89 years).In Group A,there were nine cases of T11,10 T12,13 L1,and six L2.Group B (27 cases,41 vertebrae) included 10 males and 17 females,aged (64.1 ±9.6)years (range,63-87 years).In Group B,there were seven cases of T11,13 T12,12 L1,and nine L2.The bone cement leakage before operation,after operation,and at the last follow-up were recorded.The operation time,average fluoroscopy frequency,visual analog score (VAS),vertebral reduction height,Cobb angle,and Oswestry disability index (ODI) changes were compared between two groups.Results All patients were followed up for 6-18 months (mean,12 months).The operation time was (29.3 ± 4.1)minutes in Group A and (35.7 ± 5.2) minutes in Group B (P < 0.05).The number of fluoroscopy was (9.3 ± 1.5) times in Group A and (13.1 ±3.7)times in Group B (P <0.05).The VAS at the last follow up was (1.3 ±0.3) points in Group A and (1.4 ± 0.3) points in Group B;the ODI at the last follow up was 32.5 ± 6.7in Group A and 30.5 ± 5.3 in Group B;the injured vertebral height at the last follow up was (85.3 ±9.7)% in Group A and (82.7 ±10.4)% in Group B;the Cobb angle at the last follow up was (11.3 ±5.3) ° in Group A and (12.7 ± 6.1) ° in Group B.VAS,vertebral reduction height,and Cobb angle were all improved significantly compared with those before operation (P < 0.05),but there was no significant difference between two groups (P >0.05).The leakage rate was 3% in Group A and 26% in Group B (P < O.05).Conclusion Both vesselplasty and percutaneous kyphoplasty can quickly relieve the pain and effectively restore the height of injured vertebra.But vesselplasty can reduce bone cement leakage more effectively,thus being a better treatment for osteoporotic thoracolumbar vertebral fracture in the elderly.

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