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[1]李永革.過伸復(fù)位聯(lián)合經(jīng)皮椎體后凸成形術(shù)治療椎體后壁破裂的骨質(zhì)疏松性椎體壓縮骨折[J].中醫(yī)正骨,2019,31(07):21-26.
　LI Yongge.Hyperextension reduction combined with percutaneous kyphoplasty for treatment of osteoporotic vertebral compression fracture with cracked posterior vertebral body wall[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(07):21-26.
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過伸復(fù)位聯(lián)合經(jīng)皮椎體后凸成形術(shù)治療椎體后壁破裂的骨質(zhì)疏松性椎體壓縮骨折()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第31卷
期數(shù):
2019年07期
頁碼:
21-26
欄目:
臨床研究
出版日期:
2019-07-20

文章信息/Info

Title:
Hyperextension reduction combined with percutaneous kyphoplasty for treatment of osteoporotic vertebral compression fracture with cracked posterior vertebral body wall
作者:
李永革
(濮陽市人民醫(yī)院,河南 濮陽 457000)
Author(s):
LI Yongge
The People's Hospital of Puyang City,Puyang 457000,Henan,China
關(guān)鍵詞:
脊柱骨折;  胸椎;  腰椎;  骨質(zhì)疏松性骨折;  骨折; 壓縮性;  椎體后凸成形術(shù);  過伸復(fù)位;  臨床試驗
Keywords:
spinal fractures;  thoracic vertebrae;  lumbar vertebrae;  osteoporotic fractures;  fractures; compression;  kyphoplasty;  hyperextension reduction;  clinical trial
摘要:
目的:比較過伸復(fù)位聯(lián)合經(jīng)皮椎體后凸成形術(shù)(percutaneous kyphoplasty,PKP)與單純PKP治療椎體后壁破裂的骨質(zhì)疏松性椎體壓縮骨折(osteoporotic vertebral compression fracture,OVCF)的臨床療效及安全性。方法:回顧性分析70例椎體后壁破裂的OVCF患者的病例資料,其中采用過伸復(fù)位聯(lián)合PKP治療38例(聯(lián)合組),采用PKP治療32例(PKP組)。男38例,女32例。年齡40～80歲,中位數(shù)60歲。均為單節(jié)段骨折,其中T1128例、T1222例、L111例、L29例。骨質(zhì)疏松癥病程6個月至7年,中位數(shù)3年。骨折至就診時間1～21 d,中位數(shù)11 d。比較2組患者的手術(shù)時間、術(shù)中出血量、術(shù)后住院時間,術(shù)后12 h、24 h、48 h的胸腰背部疼痛視覺模擬量表(visual analogue scale,VAS)評分,復(fù)位前、復(fù)位后即刻、術(shù)后即刻、術(shù)后3個月、術(shù)后6個月的傷椎后凸Cobb角及傷椎前緣高度,術(shù)前、術(shù)后6個月的Oswestry功能障礙指數(shù)(Oswestry disability index,ODI)及日常生活活動能力量表(activity of daily living scale,ADL)評分。隨訪觀察并發(fā)癥發(fā)生情況。結(jié)果:①一般情況。2組患者的手術(shù)時間、術(shù)中出血量、術(shù)后住院時間比較,組間差異均無統(tǒng)計學(xué)意義[(52.7±5.8)min,(53.1±4.9)min,t=0.308,P=0.759;(7.4±1.0)mL,(7.2±1.1)mL,t=0.796,P=0.429;(9.7±1.3)d,(9.5±1.2)d,t=0.664,P=0.509]。②胸腰背部疼痛VAS評分。時間因素和分組因素存在交互效應(yīng)(F=78.973,P=0.000); 2組患者胸腰背部疼痛VAS評分總體比較,組間差異有統(tǒng)計學(xué)意義,即存在分組效應(yīng)(F=5.945,P=0.000); 術(shù)后不同時間點胸腰背部疼痛VAS評分的差異有統(tǒng)計學(xué)意義,即存在時間效應(yīng)(F=61.974,P=0.000); 2組患者胸腰背部疼痛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[(6.8±1.0)分,(5.1±0.9)分,(4.2±0.7)分,F=56.134,P=0.000;(7.5±1.2)分,(6.7±1.0)分,(5.9±0.8)分,F=13.878,P=0.000]; 術(shù)后12 h、24 h、48 h,聯(lián)合組的胸腰背部疼痛VAS評分均低于PKP組(t=2.777,P=0.007; t=7.016,P=0.000; t=9.060,P=0.000)。③傷椎后凸Cobb角。時間因素和分組因素存在交互效應(yīng)(F=56.075,P=0.000); 2組患者傷椎后凸Cobb角總體比較,組間差異有統(tǒng)計學(xué)意義,即存在分組效應(yīng)(F=11.289,P=0.000); 手術(shù)前后不同時間點傷椎后凸Cobb角的差異有統(tǒng)計學(xué)意義,即存在時間效應(yīng)(F=45.201,P=0.000); 2組患者傷椎后凸Cobb角隨時間變化均呈減小趨勢,但2組的減小趨勢不完全一致(18.7°±2.4°,6.3°±1.2°,6.1°±1.3°,6.2°±1.3°,6.4°±1.2°,F=22.397,P=0.000; 18.6°±2.2°,7.9°±1.3°,7.8°±1.2°,7.9°±1.3°,7.8°±1.3°,F=15.986,P=0.000); 復(fù)位前,2組患者傷椎后凸Cobb角的組間差異無統(tǒng)計學(xué)意義(t=0.180,P=0.857); 復(fù)位后即刻、術(shù)后即刻、術(shù)后3個月、術(shù)后6個月,聯(lián)合組的傷椎后凸Cobb角均小于PKP組(t=5.350,P=0.000; t=5.644,P=0.000; t=5.450,P=0.000; t=4.681,P=0.000)。④傷椎前緣高度。時間因素和分組因素存在交互效應(yīng)(F=36.975,P=0.000); 2組患者傷椎前緣高度總體比較,組間差異有統(tǒng)計學(xué)意義,即存在分組效應(yīng)(F=15.302,P=0.000); 手術(shù)前后不同時間點傷椎前緣高度的差異有統(tǒng)計學(xué)意義,即存在時間效應(yīng)(F=22.041,P=0.000); 2組患者傷椎前緣高度隨時間變化均呈增高趨勢,但2組的增高趨勢不完全一致[(12.3±2.0)mm,(20.6±2.2)mm,(20.4±2.1)mm,(20.5±2.1)mm,(20.7±2.0)mm,F=18.957,P=0.000;(12.5±2.2)mm,(18.7±2.0)mm,(18.9±2.2)mm,(18.8±2.1)mm,(18.9±2.0)mm,F=16.093,P=0.000]; 復(fù)位前,2組患者傷椎前緣高度的組間差異無統(tǒng)計學(xué)意義(t=0.398,P=0.692); 復(fù)位后即刻、術(shù)后即刻、術(shù)后3個月、術(shù)后6個月,聯(lián)合組的傷椎前緣高度均高于PKP組(t=3.751,P=0.000; t=2.913,P=0.005; t=3.374,P=0.001; t=3.751,P=0.000)。⑤ODI。術(shù)前2組患者的ODI比較,差異無統(tǒng)計學(xué)意義(t=0.178,P=0.860); 術(shù)后6個月,2組患者的ODI均較術(shù)前降低[(64.3±4.6)%,(19.7±2.3)%,t=53.458,P=0.000;(64.1±4.8)%,(23.6±2.9)%,t=40.853,P=0.000],聯(lián)合組的ODI低于PKP組(t=6.274,P=0.000)。⑥ADL評分。術(shù)前2組患者的ADL評分比較,差異無統(tǒng)計學(xué)意義(t=0.235,P=0.815); 術(shù)后6個月,2組患者的ADL評分均較術(shù)前增高[(41.6±3.5)分,(71.8±5.0)分,t=30.503,P=0.000;(41.4±3.6)分,(66.2±5.2)分,t=22.182,P=0.000],聯(lián)合組的ADL評分高于PKP組(t=4.584,P=0.000)。⑦安全性。聯(lián)合組1例出現(xiàn)骨水泥滲漏,PKP組1例出現(xiàn)骨水泥滲漏、1例出現(xiàn)骨折畸形愈合。2組患者并發(fā)癥發(fā)生率比較,差異無統(tǒng)計學(xué)意義(χ2=0.023,P=0.879)。結(jié)論:過伸復(fù)位聯(lián)合PKP與單純PKP治療椎體后壁破裂的OVCF,二者在手術(shù)時間、術(shù)中出血量、術(shù)后住院時間及安全性方面無明顯差異,但前者的臨床療效優(yōu)于后者。
Abstract:
Objective:To compare the clinical curative effects and safety of combination therapy of hyperextension reduction and percutaneous kyphoplasty(PKP)versus monotherapy of PKP for treatment of osteoporotic vertebral compression fracture(OVCF)with cracked posterior vertebral body wall(PVBW).Methods:The medical records of 70 OVCF patients with cracked PVBW were analyzed retrospectively.Thirty-eight patients were treated with hyperextension reduction combined with PKP(combination group),and the other patients were treated with monotherapy of PKP(PKP group).The patients consisted of 38 males and 32 females,and ranged in age from 40 to 80 years(Median=60 yrs)and in disease course of osteoporosis from 6 months to 7 years(Median=3 yrs).All of the fractures belonged to single-segment fracture,which located at T11(28),T12(22),L1(11)and L2(9).The duration from fracture to visit ranged from 1 to 21 days(Median=11 days).The operative time,intraoperative blood loss,postoperative hospital stay,thoracolumbar pain visual analogue scale(VAS)scores measured at 12,24 and 48 hours after the surgery,kyphotic Cobb's angle and anterior border height of injured vertebrae measured before reduction,immediately after reduction,immediately after surgery and at 3 and 6 months after the surgery,Oswestry disability index(ODI)before surgery and at 6 months after the surgery and activity of daily living scale(ADL)scores were compared between the 2 groups.The complications were also observed.Results:There was no statistical difference in operative time,intraoperative blood loss and postoperative hospital stay between the 2 groups(52.7+/-5.8 vs 53.1+/-4.9 minutes,t=0.308,P=0.759; 7.4+/-1.0 vs 7.2+/-1.1 mL,t=0.796,P=0.429; 9.7+/-1.3 vs 9.5+/-1.2 days,t=0.664,P=0.509).There was interaction between time factor and group factor in thoracolumbar pain VAS scores(F=78.973,P=0.000).There was statistical difference in thoracolumbar pain VAS scores between the 2 groups in general,in other words,there was group effect(F=5.945,P=0.000).There was statistical difference in thoracolumbar pain VAS scores between different timepoints after the surgery,in other words,there was time effect(F=61.974,P=0.000).The thoracolumbar pain VAS scores presented a time-dependent decreasing trend in both of the 2 groups,while the 2 groups were inconsistent with each other in the decreasing tendency(6.8+/-1.0,5.1+/-0.9,4.2+/-0.7 points,F=56.134,P=0.000; 7.5+/-1.2,6.7+/-1.0,5.9+/-0.8 points,F=13.878,P=0.000).The thoracolumbar pain VAS scores were lower in combination group compared to PKP group at 12,24 and 48 hours after the surgery(t=2.777,P=0.007; t=7.016,P=0.000; t=9.060,P=0.000).There was interaction between time factor and group factor in kyphotic Cobb's angle of injured vertebrae(F=56.075,P=0.000).There was statistical difference in kyphotic Cobb's angle of injured vertebrae between the 2 groups in general,in other words,there was group effect(F=11.289,P=0.000).There was statistical difference in kyphotic Cobb's angle of injured vertebrae between different timepoints before and after the surgery,in other words,there was time effect(F=45.201,P=0.000).The kyphotic Cobb's angle of injured vertebrae presented a time-dependent decreasing trend in both of the 2 groups,while the 2 groups were inconsistent with each other in the decreasing tendency(18.7+/-2.4,6.3+/-1.2,6.1+/-1.3,6.2+/-1.3,6.4+/-1.2 degrees,F=22.397,P=0.000; 18.6+/-2.2,7.9+/-1.3,7.8+/-1.2,7.9+/-1.3,7.8+/-1.3 degrees,F=15.986,P=0.000).There was no statistical difference in kyphotic Cobb's angle of injured vertebrae between the 2 groups before reduction(t=0.180,P=0.857).The kyphotic Cobb's angles of injured vertebrae were smaller in combination group compared to PKP group immediately after reduction,immediately after surgery and at 3 and 6 months after the surgery(t=5.350,P=0.000; t=5.644,P=0.000; t=5.450,P=0.000; t=4.681,P=0.000).There was interaction between time factor and group factor in injured vertebrae anterior border height(F=36.975,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=15.302,P=0.000).There was statistical difference in injured vertebrae anterior border height between different timepoints before and after the surgery,in other words,there was time effect(F=22.041,P=0.000).The injured vertebrae anterior border height presented a time-dependent increasing trend in both of the 2 groups,while the 2 groups were inconsistent with each other in the increasing tendency(12.3+/-2.0,20.6+/-2.2,20.4+/-2.1,20.5+/-2.1,20.7+/-2.0 mm,F=18.957,P=0.000; 12.5+/-2.2,18.7+/-2.0,18.9+/-2.2,18.8+/-2.1,18.9+/-2.0 mm,F=16.093,P=0.000).There was no statistical difference in injured vertebrae anterior border height between the 2 groups before reduction(t=0.398,P=0.692).The injured vertebrae anterior border heights were higher in combination group compared to PKP group immediately after reduction,immediately after surgery and at 3 and 6 months after the surgery(t=3.751,P=0.000; t=2.913,P=0.005; t=3.374,P=0.001; t=3.751,P=0.000).There was no statistical difference in ODI between the 2 groups before the surgery(t=0.178,P=0.860).The ODI decreased in both of the 2 groups at 6 months after the surgery compared to pre-surgery(64.3+/-4.6 vs 19.7+/-2.3%,t=53.458,P=0.000; 64.1+/-4.8 vs 23.6+/-2.9%,t=40.853,P=0.000),and was lower in combination group compared to PKP group(t=6.274,P=0.000).There was no statistical difference in ADL scores between the 2 groups before surgery(t=0.235,P=0.815).The ADL scores increased in both of the 2 groups at 6 months after the surgery compared to pre-surgery(41.6+/-3.5 vs 71.8+/-5.0 points,t=30.503,P=0.000; 41.4+/-3.6 vs 66.2+/-5.2 points,t=22.182,P=0.000),and were higher in combination group compared to PKP group(t=4.584,P=0.000).The bone cement leakage was found in 1 patient in combination group and 1 patient in PKP group,and the fracture malunion was found in 1 patient in PKP group.There was no statistical difference in complication incidences between the 2 groups(χ2=0.023,P=0.879).Conclusion:There is no significant difference in operative time,intraoperative blood loss,postoperative hospital stay and safety between combination therapy of hyperextension reduction and PKP and monotherapy of PKP for treatment of OVCF with cracked PVBW,however,the former surpasses the latter in clinical curative effects.

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(收稿日期:2018-12-04 本文編輯:郭毅曼)
更新日期/Last Update: 2019-07-20