-
骨质疏松症是老年人群常见慢性疾病,好发于绝经后女性,当病人骨量下降时,骨折风险明显上升。骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCFs)是骨质疏松症最严重的并发症之一,骨折部位出现严重疼痛,具有较高的致残率及死亡率[1]。经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)是治疗OVCFs最常用的微创术式之一,通过骨水泥填充椎体间隙以恢复椎体高度,增加椎体强度及稳定性。随着OVCFs PKP病人基数的增加,术后邻椎骨折的报道逐渐增多,有报道[2]称27.8%的OVCFs病人PKP术后新发椎体骨折,其中68%发生于临近上下椎体,邻椎骨折已成为OVCFs PKP治疗后重要防治方向。对于PKP术后邻椎骨折,有学者建议采用保守治疗,但随着PKP手术经验的积累、穿刺技术以及骨水泥质量的进步,其临床治疗效果也逐渐得到完善[3]。我院近年对21例OVCFs PKP术后邻椎骨折病人再次进行PKP术治疗,获得良好的临床疗效。现作报道。
-
所有病人均成功完成手术,手术用时(49.45±6.43)min,出血量(23.23±4.87)mL,骨水泥注入量(4.91±1.21)mL。
-
术后1个月、6个月、1年VAS评分和Cobb角明显低于术前,ODI指数和椎体前缘高度比明显高于术前(P < 0.01);术后6个月、1年的VAS评分低于术后1个月(P < 0.05)、ODI指数高于术后1个月(P < 0.01);术后1年椎体前缘高度比低于术后1个月和6个月(P < 0.05)(见表 1)。
指标 术前 术后1个月 术后6个月 术后1年 F P MS组内 VAS评分/分 7.21±1.21 2.65±0.22** 2.12±0.20**# 2.14±0.16**# 323.58 < 0.01 0.395 ODI指数/% 46.22±6.85 78.62±7.34** 87.11±7.23**## 88.09±6.65**## 164.54 < 0.01 49.323 Cobb角/(°) 18.22±3.15 7.62±0.94** 7.81±0.73** 8.17±6.25** 44.75 < 0.01 12.600 椎体前缘高度比/% 63.23±6.34 90.23±3.24** 89.82±3.71** 86.03±6.88**#▲ 124.48 < 0.01 27.948 q检验:与术前比较**P < 0.01;与术后1个月比较#P < 0.05,##P < 0.01;与术后6个月比较▲P < 0.05 表 1 手术前后影像及功能症状指标比较
(n=21;$ \overline{x}\pm s$) -
术后3例病人出现慢性腰痛,经物理治疗缓解;无切口感染、骨水泥渗漏、椎体再骨折等并发症出现。
-
典型病例见图 1。
PKP治疗骨质疏松性椎体压缩骨折术后邻椎骨折的临床效果
Clinical effect of PKP in the treatment of adjacent vertebral fractures after osteoporotic vertebral compression fracture
-
摘要:
目的研究骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCFs)经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)后邻椎骨折PKP治疗效果。 方法选择21例OVCFs PKP术后邻椎骨折病人,胸椎10例,腰椎11例。所有病人再次经PKP治疗,并给予规范化抗骨质疏松药物,记录手术完成情况,比较术前与术后1个月、6个月、1年疼痛视觉模拟(VAS)评分、Oswestry功能障碍指数(ODI)、椎体前缘高度比以及Cobb角,记录并发症发生情况。 结果所有病人均成功完成手术,手术用时(49.45±6.43)min,出血量(23.23±4.87)mL,骨水泥注入量(4.91±1.21)mL。术后1个月、6个月、1年VAS评分和Cobb角明显低于术前,ODI指数和椎体前缘高度比明显高于术前(P < 0.01);术后6个月、1年的VAS评分低于术后1个月(P < 0.05)、ODI指数高于术后1个月(P < 0.01);术后1年椎体前缘高度比低于术后1个月和6个月(P < 0.05)。术后3例病人出现慢性腰痛,无切口感染、骨水泥渗漏、椎体再骨折等并发症出现。 结论OVCFs PKP术后邻椎骨折再次经PKP治疗能有效降低疼痛症状,恢复椎体高度,手术安全有效。 Abstract:ObjectiveTo study the effects of the percutaneous kyphoplasty(PKP) in the treatment of adjacent vertebral fractures after osteoporotic vertebral compression fractures(OVCFs). MethodsTwenty-one patients with OVCFs and 10 patients in thoracic vertebrae and 11 patients in lumbar vertebrae, were selected, and treated with PKP combined with standardized anti-osteoporosis drugs again.The operation was recorded.The pain visual analogue(VAS) scores, Oswestry dysfunction index(ODI), vertebral body height ratio and Cobb angle between before operation and after 1 month, 6 months and 1 year of operation were compared, and the incidence of complications were recorded in all cases. ResultsThe operations of all patients were successfully completed, and the time of surgery, amount of bleeding and amount of bone cement injection were (49.45±6.43) min, (23.23±4.87) mL and (4.91±1.21) mL, respectively.After 1 month, 6 months and 1 year of operation, the VAS score and Cobb angle were significantly lower than those before operation, and the ODI and vertebral body height ratio were significantly higher than those before operation(P < 0.01).After 6 months and 1 year of operation, the VAS score was significantly lower than that at postoperative 1 month, and the ODI was significantly higher than that that at postoperative 1 month(P < 0.05).The height ratio of the anterior border of the vertebral body at postoperative 1 year was significantly lower than that after 1 and 6 months of operation(P < 0.05).Three patients with chronic low back pain were found after operation, and no incision infection, bone cement leakage and vertebral body fracture occurred. ConclusionsThe PKP in treating adjacent vertebral fractures after OVCFs can effectively reduce pain symptoms, restore vertebral height, and is safe and effective. -
表 1 手术前后影像及功能症状指标比较
(n=21; )$ \overline{x}\pm s$ 指标 术前 术后1个月 术后6个月 术后1年 F P MS组内 VAS评分/分 7.21±1.21 2.65±0.22** 2.12±0.20**# 2.14±0.16**# 323.58 < 0.01 0.395 ODI指数/% 46.22±6.85 78.62±7.34** 87.11±7.23**## 88.09±6.65**## 164.54 < 0.01 49.323 Cobb角/(°) 18.22±3.15 7.62±0.94** 7.81±0.73** 8.17±6.25** 44.75 < 0.01 12.600 椎体前缘高度比/% 63.23±6.34 90.23±3.24** 89.82±3.71** 86.03±6.88**#▲ 124.48 < 0.01 27.948 q检验:与术前比较**P < 0.01;与术后1个月比较#P < 0.05,##P < 0.01;与术后6个月比较▲P < 0.05 -
[1] CHANG CY, TANG CH, CHEN KC, et al.The mortality and direct medical costs of osteoporotic fractures among postmenopausal women in Taiwan[J].Osteoporos Int, 2016, 27(2):665. doi: 10.1007/s00198-015-3238-3 [2] FENG H, HUANG P, ZHANG X, et al.Unilateral versus bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures:a systematic review and meta-analysis of RCTs[J].J Orthop Res, 2015, 33(11):1713. doi: 10.1002/jor.22957 [3] 邓潇, 王国毓.椎体后凸成形术后非手术椎体再发骨折的相关因素分析[J].颈腰痛杂志, 2017, 38(3):201. [4] ALTENBURY J, WORTEl K, GRAAFF CS, et al.Validation of a visual analogue score (LRTI-VAS) in non-CF bronchiectasis[J].Clin Respir J, 2016, 10(2):168. doi: 10.1111/crj.12198 [5] CHUANG ML.The Barthel index-dyspnea:a new two-dimensional dyspnea scale[J].Int J Chron Obstruct Pulmon Dis, 2016, 11(1):1843. [6] 杜亚雷, 何保玉, 滕涛.骨质疏松性椎体压缩骨折PVP或PKP术后邻近椎体再骨折的危险因素研究进展[J].实用医学杂志, 2016, 32(9):1379. doi: 10.3969/j.issn.1006-5725.2016.09.001 [7] 李蒙, 李磊, 徐磊, 等.PKP术后相邻椎体再骨折的相关因素分析[J].中国骨与关节损伤杂志, 2017, 32(7):692. [8] 李贵星.骨水泥椎体强化术后再发邻椎骨折的综合治疗[J].颈腰痛杂志, 2017, 38(5):424. [9] NORIEGA DC, RAMAJO RH, LITE IS, et al.Safety and clinical performance of kyphoplasty and Spine Jack procedures in the treatment of osteoporotic vertebral compression fractures:a pilot, monocentric, investigator-initiated study[J].Osteoporos Int, 2016, 27(6):2047. doi: 10.1007/s00198-016-3494-x [10] 彭晋升, 邹德威, 周建伟, 等.经皮椎体后凸成形术后相邻与远节段椎体再骨折危险因素分析[J].颈腰痛杂志, 2014, 35(6):414. doi: 10.3969/j.issn.1005-7234.2014.06.003 [11] LAMY O, UEBELHART B, AUBRY-ROZIER B.Risks and benefits of percutaneous vertebroplasty or kyphoplasty in the management of osteoporotic vertebral fractures[J].Osteoporos Int, 2014, 25(3):807. doi: 10.1007/s00198-013-2574-4 [12] FLANN S, NORTON J, PEMBROKB AC.Cutaneous malakoplakia in an abdominal skin fold[J].J Am Acad Dermatol, 2010, 62(5):896. doi: 10.1016/j.jaad.2008.10.044 [13] 仇志学, 单中书.28例椎体后凸成形术后邻近椎体骨折的治疗观察[J].创伤外科杂志, 2017, 19(3):203. [14] 王方, 吴强.骨质疏松模型经皮椎体后凸成形术和经皮椎体成形术术后邻近椎体骨折的研究[J].中华实验外科杂志, 2014, 31(11):2527. doi: 10.3760/cma.j.issn.1001-9030.2014.11.054