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[1]夏坤陽,慈元,李志君,等.經(jīng)皮椎體支架內(nèi)固定治療骨質(zhì)疏松性椎體壓縮骨折的臨床研究[J].中醫(yī)正骨,2022,34(08):1-7.
　XIA Kunyang,CI Yuan,LI Zhijun,et al.A clinical study of percutaneous vertebral body stenting internal fixation for treatment of osteoporotic vertebral compression fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(08):1-7.
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經(jīng)皮椎體支架內(nèi)固定治療骨質(zhì)疏松性椎體壓縮骨折的臨床研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期數(shù):
2022年08期
頁碼:
1-7
欄目:
臨床研究
出版日期:
2022-08-20

文章信息/Info

Title:
A clinical study of percutaneous vertebral body stenting internal fixation for treatment of osteoporotic vertebral compression fractures
作者:
夏坤陽; 慈元; 李志君; 張光宇
(大連市第二人民醫(yī)院,遼寧 大連 116014)
Author(s):
XIA Kunyang; CI Yuan; LI Zhijun; ZHANG Guangyu
Dalian Second People's Hospital,Dalian 116014,Liaoning,China
關(guān)鍵詞:
脊柱;  椎體;  骨質(zhì)疏松性骨折;  骨折; 壓縮性;  椎體支架;  骨折固定術(shù); 內(nèi);  后凸成型術(shù);  臨床試驗
Keywords:
spine;  vertebral body;  osteoporotic fractures;  fractures; compression;  vertebral body stenting;  fracture fixation; internal;  kyphoplasty;  clinical trial
摘要:
目的:觀察經(jīng)皮椎體支架內(nèi)固定治療骨質(zhì)疏松性椎體壓縮骨折(osteoporotic vertebral compression fracture,OVCF)的臨床療效和安全性。方法:回顧性分析80例OVCF患者的病例資料,其中采用經(jīng)皮椎體支架內(nèi)固定治療40例(經(jīng)皮椎體支架內(nèi)固定組)、采用經(jīng)皮椎體后凸成形術(shù)(percutaneous kyphoplasty,PKP)治療40例(PKP組)。比較2組患者的骨水泥注入量、術(shù)中出血量、手術(shù)時間、胸腰椎疼痛視覺模擬量表(visual analogue scale,VAS)評分、Oswestry功能障礙指數(shù)(Oswestry disability index,ODI)、傷椎Beck指數(shù)、傷椎矢狀位Cobb角和并發(fā)癥發(fā)生率。結(jié)果:①一般結(jié)果。2組患者骨水泥注入量、術(shù)中出血量、手術(shù)時間比較,組間差異均無統(tǒng)計學(xué)意義[(2.29±1.39)mL,(1.85±1.25)mL,t=-1.541,P=0.061;(6.91±2.24)mL,(5.43±1.12)mL,t=-0.480,P=0.431;(33.61±7.31)min,(25.76±2.43)min,t=-6.59,P=0.542]。②胸腰椎疼痛VAS評分。時間因素和分組因素存在交互效應(yīng)(F=44.059,P=0.000); 2組患者的胸腰椎疼痛VAS評分總體比較,組間差異無統(tǒng)計學(xué)意義,即不存在分組效應(yīng)(F=10.250,P=0.736); 手術(shù)前后不同時間點胸腰椎疼痛VAS評分的差異有統(tǒng)計學(xué)意義,即存在時間效應(yīng)(F=88.117,P=0.000); 2組患者胸腰椎疼痛VAS評分隨時間變化均呈下降趨勢,但2組的下降趨勢不完全一致[(7.95±0.59)分,(3.83±0.53)分,(2.21±0.59)分,(1.75±0.55)分,F=53.256,P=0.000;(7.88±0.57)分,(3.91±0.57)分,(2.33±0.88)分,(1.82±0.62)分,F=34.861,P=0.000]; 2組患者術(shù)前胸腰椎疼痛VAS評分比較,差異無統(tǒng)計學(xué)意義(t=0.342,P=0.731); 術(shù)后2 d、3個月、6個月經(jīng)皮椎體支架內(nèi)固定組患者胸腰椎疼痛VAS評分均低于PKP組(t=2.556,P=0.002; t=3.251,P=0.000; t=4.101,P=0.003)。③ODI。時間因素和分組因素存在交互效應(yīng)(F=45.476,P=0.000); 2組患者的ODI總體比較,組間差異無統(tǒng)計學(xué)意義,即不存在分組效應(yīng)(F=11.029,P=1.573); 手術(shù)前后不同時間點ODI的差異有統(tǒng)計學(xué)意義,即存在時間效應(yīng)(F=90.952,P=0.000); 2組患者ODI隨時間變化均呈下降趨勢,且2組的下降趨勢完全一致[(56.65±6.23)%,(20.53±3.85)%,(18.27±2.27)%,(17.13±2.615)%,F=52.586,P=0.000;(55.94±5.77)%,(20.51±3.89)%,(18.62±2.21)%,(17.31±2.11)%,F=38.366,P=0.000]; 2組患者術(shù)前及術(shù)后2 d、3個月、6個月ODI比較,組間差異均無統(tǒng)計學(xué)意義(t=-0.801,P=0.417; t=4.772,P=0.357; t=3.154,P=0.402; t=3.904,P=0.397)。④傷椎Beck指數(shù)。時間因素和分組因素存在交互效應(yīng)(F=416.582,P=0.000); 2組患者傷椎Beck指數(shù)總體比較,組間差異有統(tǒng)計學(xué)意義,即存在分組效應(yīng)(F=34.567,P=0.000); 手術(shù)前后不同時間點傷椎Beck指數(shù)差異有統(tǒng)計學(xué)意義,即存在時間效應(yīng)(F=287.312,P=0.000); 2組患者傷椎Beck指數(shù)隨時間變化均呈先上升后基本保持不變的趨勢,但2組趨勢不完全一致(0.62±0.06,0.95±0.14,0.95±0.13,0.94±0.09,F=243.085,P=0.000; 0.64±0.05,0.75±0.17,0.75±0.14,0.74±0.09,F=44.227,P=0.000); 2組患者術(shù)前傷椎Beck指數(shù)比較,差異無統(tǒng)計學(xué)意義(t=-2.932,P=0.482); 術(shù)后2 d、3個月、6個月經(jīng)皮椎體支架內(nèi)固定組患者傷椎Beck指數(shù)均高于PKP組(t=9.194,P=0.000; t=10.933,P=0.000; t=17.372,P=0.000)。⑤傷椎矢狀位Cobb角。時間因素和分組因素存在交互效應(yīng)(F=18.642,P=0.000); 2組患者的傷椎矢狀位Cobb角總體比較,組間差異無統(tǒng)計學(xué)意義,即不存在分組效應(yīng)(F=8.822,P=0.639); 手術(shù)前后不同時間點傷椎矢狀位Cobb角的差異有統(tǒng)計學(xué)意義,即存在時間效應(yīng)(F=63.503,P=0.000); 2組患者傷椎矢狀位Cobb角隨時間變化均呈先下降后基本保持不變的趨勢,但2組趨勢不完全一致(18.85°±3.32°,11.89°±1.84°,12.21°±1.34°,11.62°±1.55°,F=25.137,P=0.000; 18.66°±3.15°,14.54°±4.21°,15.23°±3.52°,14.21°±2.77°,F=38.366,P=0.000); 2組患者術(shù)前傷椎矢狀位Cobb角比較,差異無統(tǒng)計學(xué)意義(t=0.102,P=0.635); 術(shù)后2 d、3個月、6個月經(jīng)皮椎體支架內(nèi)固定組患者傷椎矢狀位Cobb角均小于PKP組(t=2.013,P=0.001; t=3.205,P=0.000; t=3.502,P=0.003)。⑥并發(fā)癥發(fā)生率。經(jīng)皮椎體支架內(nèi)固定組發(fā)生骨水泥滲漏1例,PKP組發(fā)生骨水泥滲漏10例。2組患者均未發(fā)生相鄰椎體骨折、神經(jīng)根損傷等并發(fā)癥。經(jīng)皮椎體支架內(nèi)固定組患者并發(fā)癥發(fā)生率低于PKP組(χ2=8.538,P=0.003)。結(jié)論:經(jīng)皮椎體支架內(nèi)固定治療OVCF,與PKP相比,二者在骨水泥注入量、術(shù)中出血量、手術(shù)時間及恢復(fù)椎體功能方面相當(dāng),但前者更有利于緩解胸腰椎疼痛、恢復(fù)椎體正常形態(tài),且安全性高。
Abstract:
Objective:To observe the clinical outcomes and safety of percutaneous vertebral body stenting(VBS)internal fixation for treatment of osteoporotic vertebral compression fractures(OVCFs).Methods:The medical records of 80 OVCFs patients were analyzed retrospectively.Forty patients were treated with percutaneous VBS internal fixation(percutaneous VBS internal fixation group)and 40 ones with percutaneous kyphoplasty(PKP)(PKP group).The consumption of bone cement,intraoperative blood loss,operative time,thoracolumbar pain visual analogue scale(VAS)score,Oswestry disability index(ODI),injured vertebrae Beck index,injured vertebrae sagittal Cobb's angle and complication incidence were compared between the 2 groups.Results:①There was no statistical difference in consumption of bone cement,intraoperative blood loss and operative time between the 2 groups(2.29±1.39 vs 1.85±1.25 mL,t=-1.541,P=0.061; 6.91±2.24 vs 5.43±1.12 mL,t=-0.480,P=0.431; 33.61±7.31 vs 25.76±2.43 minutes,t=-6.59,P=0.542).②There was interaction between time factor and group factor in thoracolumbar pain VAS score(F=44.059,P=0.000).There was no statistical difference in thoracolumbar pain VAS scores between the 2 groups in general,in other words,there was no group effect(F=10.250,P=0.736).There was statistical difference in thoracolumbar pain VAS scores between different timepoints before and after the surgery,in other words,there was time effect(F=88.117,P=0.000).The thoracolumbar pain VAS scores presented a downward trend over time in the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(7.95±0.59,3.83±0.53,2.21±0.59,1.75±0.55 points,F=53.256,P=0.000; 7.88±0.57,3.91±0.57,2.33±0.88,1.82±0.62 points,F=34.861,P=0.000).There was no statistical difference in thoracolumbar pain VAS scores between the 2 groups before the surgery(t=0.342,P=0.731),while the thoracolumbar pain VAS scores decreased in percutaneous VBS internal fixation group compared to PKP group at postsurgical day 2,month 3 and month 6(t=2.556,P=0.002; t=3.251,P=0.000; t=4.101,P=0.003).③There was interaction between time factor and group factor in ODI(F=45.476,P=0.000).There was no statistical difference in ODI between the 2 groups in general,in other words,there was no group effect(F=11.029,P=1.573).There was statistical difference in ODI between different timepoints before and after the surgery,in other words,there was time effect(F=90.952,P=0.000).The ODI presented a downward trend over time in the 2 groups,and the 2 groups were completely consistent with each other in the variation tendency(56.65±6.23,20.53±3.85,18.27±2.27,17.13±2.615%,F=52.586,P=0.000; 55.94±5.77,20.51±3.89,18.62±2.21,17.31±2.11%,F=38.366,P=0.000).There was no statistical difference in ODI between the 2 groups before the surgery and at postsurgical day 2,month 3 and month 6(t=-0.801,P=0.417; t=4.772,P=0.357; t=3.154,P=0.402; t=3.904,P=0.397).④There was interaction between time factor and group factor in injured vertebrae Beck index(F=416.582,P=0.000).There was statistical difference in injured vertebrae Beck index between the 2 groups in general,in other words,there was group effect(F=34.567,P=0.000).There was statistical difference in injured vertebrae Beck index between different timepoints before and after the surgery,in other words,there was time effect(F=287.312,P=0.000).The injured vertebrae Beck index presented a trend of going upward firstly and remaining basically unchanged subsequently over time in the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(0.62±0.06,0.95±0.14,0.95±0.13,0.94±0.09,F=243.085,P=0.000; 0.64±0.05,0.75±0.17,0.75±0.14,0.74±0.09,F=44.227,P=0.000).There was no statistical difference in injured vertebrae Beck index between the 2 groups before the surgery(t=-2.932,P=0.482),while the injured vertebrae Beck indexes increased in percutaneous VBS internal fixation group compared to PKP group at postsurgical day 2,month 3 and month 6(t=9.194,P=0.000; t=10.933,P=0.000; t=17.372,P=0.000).⑤There was interaction between time factor and group factor in injured vertebrae sagittal Cobb's angle(F=18.642,P=0.000).There was no statistical difference in injured vertebrae sagittal Cobb's angle between the 2 groups in general,in other words,there was no group effect(F=8.822,P=0.639).There was statistical difference in injured vertebrae sagittal Cobb's angle between different timepoints before and after the surgery,in other words,there was time effect(F=63.503,P=0.000).The injured vertebrae sagittal Cobb's angle presented a trend of going downward firstly and remaining basically unchanged subsequently over time in the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(18.85±3.32,11.89±1.84,12.21±1.34,11.62±1.55 degrees,F=25.137,P=0.000; 18.66±3.15,14.54±4.21,15.23±3.52,14.21±2.77 degrees,F=38.366,P=0.000).There was no statistical difference in injured vertebrae sagittal Cobb's angle between the 2 groups before the surgery(t=0.102,P=0.635),while the injured vertebrae sagittal Cobb's angle decreased in percutaneous VBS internal fixation group compared to PKP group at postsurgical day 2,month 3 and month 6(t=2.013,P=0.001; t=3.205,P=0.000; t=3.502,P=0.003).⑥The bone cement leakage was found in 1 patient in percutaneous VBS internal fixation group and 10 patients in PKP group.No complications such as adjacent vertebral fracture and nerve root injury were found in the 2 groups.The complication incidence rate was lower in percutaneous VBS internal fixation group compared to PKP group(χ2=8.538,P=0.003).Conclusion:The percutaneous VBS internal fixation is similar to PKP in consumption of bone cement,intraoperative blood loss,operative time and vertebral function recovery in treatment of OVCFs,while the former can be more conducive to thoracolumbar pain relief and vertebral body morphology recovery with high safety compared to the latter.

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(收稿日期:2021-08-16 本文編輯:呂寧)

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更新日期/Last Update: 1900-01-01