经皮可弯曲椎体后凸成形术治疗骨质疏松性椎体压缩骨折的临床效果
The clinical effect of percutaneous curved kyphoplasty for osteoporosis vertebral compression fractures
目的:研究经皮可弯曲椎体后凸成形术(PCK)治疗骨质疏松性椎体压缩骨折(OVCF)的临床效果。方法:本研究为前瞻性研究。纳入2018年6月至2019年6月于首都医科大学附属北京朝阳医院骨科行PCK治疗的OVCF患者。手术均由同一医师完成,入组患者手术前后行X线检查测量椎体高度及Cobb角,评估疼痛视觉模拟评分(VAS)及Oswestry功能障碍指数(ODI)评分;记录术中骨水泥注入量;术后行CT检查观察骨水泥渗漏率及骨水泥分布;收集术后并发症情况。手术前后相关指标的比较采用配对样本 t检验。 结果:研究共入组32例患者,男性8例,女性24例,年龄(74.9±9.9)岁(范围:64~81岁),术中骨水泥注入量为(4.2±1.5)ml(范围:2~6 ml),骨水泥分布Ⅰ型28例,Ⅱ型4例;12例(37.5%)出现骨水泥渗漏,无椎管内渗漏及静脉渗漏发生。患者的椎体高度从术前的(21.9±6.2)mm改善至术后即刻的(24.3±4.3)mm( t=-2.836, P=0.008);Cobb角从术前的[ M( QR)] 14°(15°)改善至术后即刻的12.5°(12.75°)( Z=-1.950, P=0.051);VAS从术前的(6.8±0.7)分改善至术后即刻的(1.7±0.8)分( t=28.946, P<0.01);ODI评分从术前的(73.4±7.3)改善至术后即刻的(21.3±5.7)分( t=32.250, P<0.01)。患者术后随访(19.7±3.7)个月(范围:15~29个月),1例患者发生再骨折(3.1%,1/32),无患者出现神经功能减退、肺栓塞等并发症。 结论:应用PCK治疗OVCFs患者临床效果良好,骨水泥分布满意。
更多Objective:To evaluate the clinical effect of percutaneous curved kyphoplasty (PCK) for osteoporosis vertebral compression fractures (OVCF).Methods:This is a prospective study.Patients with OVCF who underwent PCK at the Department of Orthopedics,Beijing Chaoyang Hospital, Capital Medical University from June 2018 to June 2019 were included.All the operations were performed by the same surgeon.X-ray examination was performed before and after the operation to measure the vertebral height and Cobb angle.The visual analogue scale (VAS) and Oswestry disability index (ODI) scores were evaluated before and after the operation,and the amount of bone cement injected was record.The leakage rate and distribution of bone cement was observed by CT examination after the operation,and the postoperative complications was collected during the follow-up.Paired- t test was used to compare the related indexes before and after operation. Results:There were 32 patients in our study,including 8 males and 24 females,aged (74.9±9.9) years (range:64 to 81 years).The intraoperative bone cement injection volume was (4.2±1.5) ml(range:2 to 6 ml).According to the classification of distribution of bone cement,28 cases were rated as type Ⅰ and 4 cases were rated as type Ⅱ. Bone cement leakage was observed in 12 cases (37.5%),and there was no intraspinal leakage or venous leakage.The vertebral height was improved from (21.9±6.2) mm preoperatively to (24.3±4.3) mm postoperatively( t=-2.836, P=0.008),Cobb angle improved from( M( QR))14°(15°)preoperatively to 12.5°(12.75°)postoperatively( Z=-1.950, P=0.051),VAS improved from 6.8±0.7 preoperatively to 1.7±0.8 postoperatively ( t=28.946, P<0.01),ODI score improved from 73.4±7.3 preoperatively to 21.3±5.7 postoperatively ( t=32.250, P<0.01).The patients were followed up for (19.7±3.7) months (range:15 to 29 months).One patient had refracture (3.1%,1/32),and no other complications such as neurological dysfunction and pulmonary embolism occurred. Conclusions:The clinical effect of PCK in the treatment of OVCF was satisfactory.This technique could reduce the difficulty of puncture to a certain extent,and be beneficial to the distribution of bone cement.
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