应用非对称性渐进分步骨水泥填充法治疗胸腰段压缩骨折的疗效分析

摘要

目的 探讨在椎体成形术中应用非对称性渐进分步骨水泥填充法治疗骨质疏松性胸腰段椎体压缩骨折的中期疗效.方法 2012-09-2013-09,应用椎体后凸成形术治疗96例骨质疏松性胸腰段椎体压缩骨折患者.将96例患者分为两组:A组为椎体两侧对称等量骨水泥填充组,B组为椎体两侧非对称不等量骨水泥填充组,各48例.统计分析手术前后骨折椎体平均高度、视觉模拟评分(VAS)、ODI指数、后凸角(Cobb角)变化以及骨水泥渗漏情况;并随访至少3年以统计术后再骨折发生率.结果 96例均获随访,随访36～42个月(平均36.9个月).与术前相比,所有患者术后骨折椎体平均高度、VAS评分、ODI指数和Cobb角均明显改善.两组间术后骨折椎体平均高度、VAS评分和ODI指数无明显差异;两组间术后即刻Cobb角无差异,但末期随访Cobb角有差异(P＜0.05).A组骨水泥渗漏率及再骨折发生率较B组高,差异有统计学意义(P＜0.05).结论 在椎体后凸成形术中应用非对称性渐进分步骨水泥填充法是治疗骨质疏松性胸腰段椎体压缩骨折更加安全而有效的方法.%Objective To evaluate the therapeutic effects of percutaneous kyphoplasty (PKP)with asymmetric progressive bone cement filling method for thoracolumbar osteoporotic vertebral compression fractures (OVCF).Methods From September 2012 to September 2013,96 OVCF-patients were treated with PKP.All the patients were divided into two groups on average,group A:symmetric equivalent of bone cement filling in PKP;group B:asymmetric inequality of bone cement filling in PKP.The average height of vertebral body,pain visual analogue scale (VAS),ODI index,Cobb angle and the leakage rate of bone cement were recorded and analyzed before and after surgery.All the patients were followed-up at least 3 years to evaluate the refracture rate after operation.Results The follow-up ranged from 36 to 42 months,average 36.9 months.The average height of vertebral body,VAS,ODI index,Cobb angle of all the patients were significantly improved after surgery.There were no significant differences between the two groups in VAS score,ODI index and the average height of vertebral body.But there were significant differences in the leakage rate of bone cement and refracture rate after surgery and the last follow-up (P＜0.05).Conclusion The method of asymmetric progressive bone cement filling is a safer and more effective treatment for thoracolumbar OVCF.