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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:

第26卷

期數(shù):

2014年03期

頁(yè)碼:

25-29

欄目:

脊柱微創(chuàng)技術(shù)

出版日期:

2014-03-30

文章信息/Info

Title:

Clinical study on hyperextension traction elastic pressure combined with percutaneous vertebroplasty in the treatment of osteoporotic thoracolumbar vertebral compression fractures

作者:

何升華; 馬篤軍; 余偉吉; 王業(yè)廣; 孫志濤

廣東省深圳市中醫(yī)院,廣東 深圳 518033

Author(s):

He Shenghua^*; Ma Dujun; Yu Weiji; Wang Yeguang; Sun Zhitao.

^*Shenzhen Hospital of Traditional Chinese Medicine,Shenzhen 518033,Guangdong,China

關(guān)鍵詞:

脊柱骨折 骨折; 壓縮性 胸椎 腰椎 椎體成形術(shù) 骨牽引復(fù)位法 治療; 臨床研究性

Keywords:

Spinal fractures;  Fractures; compression;  Thoracic vertebrae;  Lumbar vertebrae;  Vertebroplasty;  Skeletal tracting reposition;  Therapies; investigational

摘要:

目的:觀察過(guò)伸牽引彈性按壓法聯(lián)合經(jīng)皮椎體成形術(shù)治療骨質(zhì)疏松性胸腰椎壓縮骨折的臨床療效和安全性。方法:將符合要求的90例骨質(zhì)疏松性胸腰椎壓縮骨折患者隨機(jī)分為2組,每組45例。所有患者入院后均臥硬板床,后背墊軟枕。治療組采用過(guò)伸牽引彈性按壓法聯(lián)合經(jīng)皮椎體成形術(shù)治療,對(duì)照組單純采用經(jīng)皮椎體成形術(shù)治療。比較2組患者治療前、治療后24 h及治療后6個(gè)月的傷椎前緣高度、脊柱后凸Cobb's角、腰背部疼痛視覺(jué)模擬評(píng)分、Oswsetry功能障礙指數(shù)評(píng)分及并發(fā)癥發(fā)生情況。結(jié)果:①傷椎前緣高度。治療前后不同時(shí)間傷椎前緣高度的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)[治療組:(15.14±2.61)mm,(26.79±2.25)mm,(26.68±2.53)mm; 對(duì)照組:(15.98±2.47)mm,(19.85±2.73)mm,(19.68±2.59)mm; F=22.532,P=0.031]; 2組患者傷椎前緣高度的組間差異總體上有統(tǒng)計(jì)學(xué)意義,即存在分組效應(yīng)(F=5.421,P=0.000); 除治療前外(t=2.138,P=0.261),其余各時(shí)點(diǎn)對(duì)照組的傷椎前緣高度均小于治療組(t=4.063,P=0.000; t=6.124,P=0.000); 時(shí)間因素和分組因素之間存在交互效應(yīng)(F=35.835,P=0.000)。②脊柱后凸Cobb's角。治療前后不同時(shí)間脊柱后凸Cobb's角的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)[治療組:(27.86°±1.81°),(8.24°±1.37°),(8.31°±1.63°); 對(duì)照組:(27.43°±1.57°),(14.62°±1.55°),(14.75°±1.48°); F=22.462,P=0.021]; 2組患者脊柱后凸Cobb's角的組間差異總體上有統(tǒng)計(jì)學(xué)意義,即存在分組效應(yīng)(F=4.736,P=0.000); 除治療前外(t=1.729,P=0.186),其余各時(shí)點(diǎn)對(duì)照組的脊柱后凸Cobb's角均大于治療組(t=2.521,P=0.000; t=4.416,P=0.000); 時(shí)間因素和分組因素之間存在交互效應(yīng)(F=39.421,P=0.000)。③腰背部疼痛視覺(jué)模擬評(píng)分。治療前后不同時(shí)間腰背部疼痛視覺(jué)模擬評(píng)分的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)[治療組:(8.62±1.53)分,(2.05±1.64)分,(1.52±1.24)分; 對(duì)照組:(8.58±1.73)分,(2.41±1.74)分,(1.78±1.36)分; F=29.361,P=0.003]; 2組患者腰背部疼痛視覺(jué)模擬評(píng)分的組間差異總體上有統(tǒng)計(jì)學(xué)意義,即存在分組效應(yīng)(F=1.104,P=0.032); 除治療前外(t=0.482,P=0.763),其余各時(shí)點(diǎn)對(duì)照組的腰背部疼痛視覺(jué)模擬評(píng)分均大于治療組(t=1.116,P=0.024; t=1.048,P=0.041); 時(shí)間因素和分組因素之間存在交互效應(yīng)(F=30.821,P=0.013)。④Oswsetry功能障礙指數(shù)評(píng)分。治療前后不同時(shí)間Oswsetry功能障礙指數(shù)評(píng)分的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)[治療組:(79.68±4.21)分,(30.36±4.83)分,(21.23±4.61)分; 對(duì)照組:(78.74±4.61)分,(33.72±5.72)分,(24.28±4.42)分; F=33.725,P=0.001]; 2組患者Oswsetry功能障礙指數(shù)評(píng)分的組間差異總體上有統(tǒng)計(jì)學(xué)意義,即存在分組效應(yīng)(F=3.672,P=0.048); 除治療前外(t=3.227,P=0.281),其余各時(shí)點(diǎn)對(duì)照組的Oswsetry功能障礙指數(shù)評(píng)分均大于治療組(t=7.149,P=0.022; t=4.015,P=0.037); 時(shí)間因素和分組因素之間存在交互效應(yīng)(F=26.815,P=0.027)。⑤并發(fā)癥發(fā)生情況。2組患者術(shù)中及隨訪期間均未發(fā)生神經(jīng)、脊髓損傷及感染等并發(fā)癥。結(jié)論:過(guò)伸牽引彈性按壓法聯(lián)合經(jīng)皮椎體成形術(shù)治療骨質(zhì)疏松性胸腰椎壓縮骨折,在恢復(fù)傷椎高度、糾正脊柱后凸畸形、緩解腰背部疼痛和恢復(fù)脊柱功能方面優(yōu)于單純經(jīng)皮椎體成形術(shù)治療,而且安全性較高。

Abstract:

Objective:To observe the clinical curative effects and safety of hyperextension traction elastic pressure combined with percutaneous vertebroplasty(PVP)in the treatment of osteoporotic thoracolumbar vertebral compression fractures.Methods:Ninety patients with osteoporotic thoracolumbar vertebral compression fracture enrolled in the study were randomly divided into 2 groups,45 cases in each group.All patients in the 2 groups were ordered to stay in hard bed with a soft pillow under the low back.Patients in the treatment group were treated with hyperextension traction elastic pressure combined with PVP,while the others in the control group were treated with monotherapy of PVP.Anterior border height of injured vertebrae,kyphosis Cobb angle,visual analogue scores(VAS),Oswsetry disability index(ODI)and complications were compared between the 2 groups before the treatment and at 24 hrs and 6 months after the treatment respectively.Results:There was statistical difference in the anterior border height of injured vertebrae between different time points,in other words,there was time effect(treatment group:15.14+/-2.61,26.79+/-2.25,26.68+/-2.53 mm; control group:15.98+/-2.47,19.85+/-2.73,19.68+/-2.59 mm; F=22.532,P=0.031).There was statistical difference in the anterior border height of injured vertebrae between the 2 groups in general,in other words,there was grouping effect(F=5.421,P=0.000).The anterior border height of injured vertebrae of control group was less than that of treatment group at posttreatment time points(t=4.063,P=0.000; t=6.124,P=0.000)and there was no statistical difference between them at pretreatment time point(t=2.138,P=0.261).There was interaction between time factor and grouping factor(F=35.835,P=0.000).There was statistical difference in kyphotic Cobb angle between different time points,in other words,there was time effect(treatment group:27.86+/-1.81,8.24+/-1.37,8.31+/-1.63 degrees; control group:27.43+/-1.57,14.62+/-1.55,14.75+/-1.48 degrees; F=22.462,P=0.021).There was statistical difference in kyphotic Cobb angle between the 2 groups in general,in other words,there was grouping effect(F=4.736,P=0.000).The kyphotic Cobb angle of control group was higher than that of treatment group at posttreatment time points(t=2.521,P=0.000; t=4.416,P=0.000)and there was no statistical difference between them at pretreatment time point(t=1.729,P=0.186).There was interaction between time factor and grouping factor(F=39.421,P=0.000).There was statistical difference in VAS of lower back pain between different time points,in other words,there was time effect(treatment group:8.62+/-1.53,2.05+/-1.64,1.52+/-1.24 points; control group:8.58+/-1.73,2.41+/-1.74,1.78+/-1.36 points; F=29.361,P=0.003).There was statistical difference in the VAS of lower back pain between the 2 groups in general,in other words,there was grouping effect(F=1.104,P=0.032).The VAS of lower back pain of control group was higher than that of treatment group at posttreatment time points(t=1.116,P=0.024; t=1.048,P=0.041)and there was no statistical difference between them at pretreatment time point(t=0.482,P=0.763).There was interaction between time factor and grouping factor(F=30.821,P=0.013).There was statistical difference in the ODI between different time points,in other words,there was time effect(treatment group:79.68+/-4.21,30.36+/-4.83,21.23+/-4.61 points; control group:78.74+/-4.61,33.72+/-5.72,24.28+/-4.42 points; F=33.725,P=0.001).There was statistical difference in the ODI between the 2 groups in general,in other words,there was grouping effect(F=3.672,P=0.048).The ODI of control group was higher than that of treatment group at posttreatment time points(t=7.149,P=0.022; t=4.015,P=0.037)and there was no statistical difference between them at pretreatment time point(t=3.227,P=0.281).There was interaction between time factor and grouping factor(F=26.815,P=0.027).No complications such as nerve injury,spinal cord injury and infection were found in the 2 groups.Conclusion:For treatment of osteoporotic thoracolumbar vertebral compression fractures,the combination therapy of hyperextension traction elastic pressure combined with PVP surpasses the monotherapy of PVP in the effect on injured vertebral height restoration,kyphosis correction,lower back pain relief and spinal function restoration,meanwhile it has high safety.

備注/Memo

備注/Memo:

基金項(xiàng)目:廣東省中醫(yī)藥局課題(20132026)

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更新日期/Last Update: 2014-03-20