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[1]陳建德,樊曉琦,夏炳江,等.球囊擴張部位對椎體后凸成形術治療骨質疏松性椎體壓縮骨折療效及安全性的影響[J].中醫(yī)正骨,2017,29(02):11-16.
　CHEN Jiande,FAN Xiaoqi,XIA Bingjiang,et al.Influence of balloon dilation position on curative effect and safety of percutaneous kyphoplasty for treatment of osteoporotic vertebral compression fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(02):11-16.
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球囊擴張部位對椎體后凸成形術治療骨質疏松性椎體壓縮骨折療效及安全性的影響()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第29卷
期數(shù):
2017年02期
頁碼:
11-16
欄目:
臨床研究
出版日期:
2017-02-20

文章信息/Info

Title:
Influence of balloon dilation position on curative effect and safety of percutaneous kyphoplasty for treatment of osteoporotic vertebral compression fractures
作者:
陳建德; 樊曉琦; 夏炳江; 凌義龍
浙江省紹興市中醫(yī)院,浙江 紹興 312300
Author(s):
CHEN Jiande; FAN Xiaoqi; XIA Bingjiang; LING Yilong
Shaoxing Hospital of Traditional Chinese Medicine,Shaoxing 312300,Zhejiang,China
關鍵詞:
骨質疏松性骨折;  脊柱骨折;  椎體后凸成形術;  臨床試驗
Keywords:
osteoporotic fractures;  spinal fractures;  kyphoplasty;  clinical trial
摘要:
目的:探討經(jīng)皮椎體后凸成形術(percutaneous kyphoplasty,PKP)治療骨質疏松性椎體壓縮骨折(osteoporotic vertebral compression fractures,OVCF)時,球囊擴張部位對手術療效及安全性的影響。方法:回顧性分析47例采用PKP治療的新鮮單節(jié)段OVCF患者的病例資料。24例球囊擴張部位位于骨折線處(骨折線組),其余23例球囊擴張部位未位于骨折線處(非骨折線組)。比較2組患者的傷椎前緣高度、疼痛視覺模擬量表(visual analogue scale,VAS)評分、Oswestry功能障礙指數(shù)(Oswestry disability index,ODI)評分及治療、隨訪期間的并發(fā)癥發(fā)生情況。結果:所有患者均順利完成手術,未發(fā)生脊髓、神經(jīng)根損傷及肺栓塞等并發(fā)癥; 9例發(fā)生骨水泥滲漏,其中骨折線組3例向側前方滲漏、2例向椎間盤滲漏,非骨折線組向側前方和椎間盤滲漏各2例,9例患者均未出現(xiàn)臨床癥狀。2組患者并發(fā)癥發(fā)生率比較,差異無統(tǒng)計學意義(χ2=0.000,P=1.000)。手術前后不同時間傷椎前緣高度的差異有統(tǒng)計學意義,即存在時間效應(F=117.624,P=0.000); 2組患者傷椎前緣高度總體上比較,組間差異有統(tǒng)計學意義,即存在分組效應(F=4.127,P=0.048); 除術前外[(18.69±3.17)mm,(18.70±2.96)mm,t=0.451,P=0.654],術后3 d和術后3個月時骨折線組的傷椎前緣高度均大于非骨折線組[(21.56±1.57)mm,(20.30±1.98)mm,t=2.127,P=0.039;(21.42±1.54)mm,(20.14±2.00)mm,t=2.145,P=0.037]。時間因素與分組因素存在交互效應(F=9.808,P=0.003)。手術前后不同時間疼痛VAS評分的差異有統(tǒng)計學意義,即存在時間效應(F=760.314,P=0.000); 2組疼痛VAS評分總體上比較,組間差異有統(tǒng)計學意義,即存在分組效應(F=4.911,P=0.032); 除術前外[(7.96±0.86)分,(7.78±0.95)分,t=0.665,P=0.509],術后3 d和術后3個月時骨折線組的疼痛VAS評分均小于非骨折線組[(2.41±0.88)分,(2.95±0.93)分,t=2.046,P=0.047;(2.08±0.78)分,(2.56±0.73)分,t=2.194,P=0.033]。時間因素與分組因素存在交互效應(F=3.119,P=0.049)。手術前后不同時間ODI評分的差異有統(tǒng)計學意義,即存在時間效應(F=2 018.591,P=0.000); 2組ODI評分總體上比較,組間差異有統(tǒng)計學意義,即存在分組效應(F=4.168,P=0.047); 除術前外[(39.54±2.23)分,(39.13±1.94)分,t=0.674,P=0.504],術后3 d和術后3個月時骨折線組的ODI評分均小于非骨折線組[(22.67±1.90)分,(24.35±2.32)分,t=2.716,P=0.009;(14.38±1.58)分,(15.61±1.44)分,t=2.793,P=0.008]。時間因素與分組因素存在交互效應(F=4.014,P=0.021)。結論:采用PKP治療OVCF時,在骨折處進行球囊擴張更有利于恢復傷椎高度、減輕疼痛、恢復功能,并且具有較高的安全性。
Abstract:
Objective:To explore the influence of balloon dilation position on curative effect and safety of percutaneous kyphoplasty(PKP)for treatment of osteoporotic vertebral compression fractures(OVCF).Methods:The medical records of 47 patients with fresh single-segment OVCF who were treated with PKP were analyzed retrospectively.The dilated balloon was placed at fracture line for 24 patients(fracture line group)and at other position for 23 patients(non-fracture line group).The injured vertebrae anterior border height,pain visual analogue scale(VAS)scores,Oswestry disability index(ODI)scores and complications during the treatment period and follow-up period were compared between the 2 groups.Results:The surgery were finished successfully in all patients and no complications such as spinal cord injuries,nerve-root injuries and pulmonary embolism were found.The bone cement leakage were found in 9 patients,whlie no patient developed clinical symptoms.Anterolateral leakage(3)and leakage into intervertebral disc(2)were found in fracture line group,while anterolateral leakage(2)and leakage into intervertebral disc(2)were found in non-fracture line group.There was no statistical difference in complication incidences between the two groups(χ2=0.000,P=1.000).There was statistical difference in the injured vertebrae anterior border height between different timepoints,in other words,there was time effect(F=117.624,P=0.000).There was statistical difference in injured vertebrae anterior border height between the 2 groups in general,in other words,there was group effect(F=4.127,P=0.048).There was no statistical difference in injured vertebrae anterior border height between the 2 groups before the surgery(18.69+/-3.17 vs 18.70+/-2.96 mm,t=0.451,P=0.654).The injured vertebrae anterior border height were higher in fracture line group compared to non-fracture line group at 3 days and 3 months after the surgery(21.56+/-1.57 vs 20.30+/-1.98 mm,t=2.127,P=0.039; 21.42+/-1.54 vs 20.14+/-2.00 mm,t=2.145,P=0.037).There was interaction between time factor and group factor(F=9.808,P=0.003).There was statistical difference in the pain VAS scores between different timepoints,in other words,there was time effect(F=760.314,P=0.000).There was statistical difference in pain VAS scores between the 2 groups in general,in other words,there was group effect(F=4.911,P=0.032).There was no statistical difference in pain VAS scores between the 2 groups before the surgery(7.96+/-0.86 vs 7.78+/-0.95 points,t=0.665,P=0.509).The pain VAS scores were less in fracture line group compared to non-fracture line group at 3 days and 3 months after the surgery(2.41+/-0.88 vs 2.95+/-0.93 points,t=2.046,P=0.047; 2.08+/-0.78 vs 2.56+/-0.73 points,t=2.194,P=0.033).There was interaction between time factor and group factor(F=3.119,P=0.049).There was statistical difference in the ODI scores between different timepoints,in other words,there was time effect(F=2 018.591,P=0.000).There was statistical difference in ODI scores between the 2 groups in general,in other words,there was group effect(F=4.168,P=0.047).There was no statistical difference in ODI scores between the 2 groups before the surgery(39.54+/-2.23 vs 39.13±+/-1.94 points,t=0.674,P=0.504).The ODI scores were less in fracture line group compared to non-fracture line group at 3 days and 3 months after the surgery(22.67+/-1.90 vs 24.35+/-2.32 points,t=2.716,P=0.009; 14.38+/-1.58 vs 15.61+/-1.44 points,t=2.793,P=0.008).There was interaction between time factor and group factor(F=4.014,P=0.021).Conclusion:The balloon dilatation at fracture sites is conducive to alleviating pain and recovering height and function of injured vertebrae with high safety in treatment of OVCF by PKP.

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備注/Memo

備注/Memo:
基金項目:浙江省中醫(yī)藥(中西醫(yī)結合)重點學科建設項目(2012-XK-A32)
通訊作者:陳建德 E-mail:[email protected]
更新日期/Last Update: 2017-08-07