椎体后凸成形术治疗骨质疏松性椎体压缩骨折的临床研究

摘要目的：随着老龄人口的增多，老年骨质疏松性椎体压缩性骨折（Osteoporotic Vertebral Compression Fracture，ovcr）的发病率也逐年增高。本文探讨椎体后凸成形术（PercutaneousKyphoplasty，PKP）对0VCF的疼痛缓解及功能改善等方面的临床疗效，并探讨其发展过程、作用机理及并发症的防治。方法：回顾性分析2007年1月至2011年12月应用PKP治疗的OVCF158例患者，其中男55例，女103例；患者年龄52--87岁，平均68．7岁。对患者术前、术后1日、术后3个月随访时的疼痛（VAs）及功能情况（ODD进行评价，并对以上数据进行配对t检验。结果：全部病例均顺利完成手术，3例出现椎体间隙渗漏，5例渗漏至椎体周缘，2例骨水泥渗漏至椎管内，无神经根和脊髓受压症状。VAS评分评价，术前（7．60±0．95）分，术后1日（1．00±0．74）分，术后三个月（0．20±0．48）分，术后疼痛缓解有统计学意义（P〈0．01）；ODI，术前（84．94±4-36）％，术后1日（20．47±3．61）％，术后三个月（9．85±3．43m，术后功能恢复有统计学意义（P〈0．01）。结论：PKP术后1日患者疼痛及功能较术前均有明显改善，术后3个月较术后1日亦有进一步的改观。术后后续应用治疗骨质疏松药物及康复治疗可改善患者骨质，预防相邻椎体及其他部位骨质骨折，使疗效更加满意。PKP为治疗OVCF提供了一种安全、有效的方法，可以迅速缓解疼痛，改善功能，具有广阔的应用前景。

The Efficacy Evaluation of the Percutaneous Kyphoplasty for the Aged Patients with the Osteoporotic Vertebral Compression Fracture

Objective： With the increase of aging population, the old Osteoporotic Vertebral Compression Fractures （Osteoporotic Vertebral Compression Fracture, OVCF） incidence also increased year by year. This research evaluated the efficacy of the percutaneous kyphoplasty （PKP） for the aged patients with the OVCF in pain relief and functional improvement, and discussed the development pro- cess, mechanism and prevention of complications. Methods： Aretrospective study was carried out for 158 patients with the OVCF from January 2007 to December 2011.55 patients were males and 103 were females. The average age of the patients was 68.7 years old with the range of 52 to 87 years. Evaluate the Visual analog scale （VAS） and oswestry disability index （ODD at before operation, the lth day after operation and 3 months later after operation, then make these date paired t test. Results： Operations in all patients were completed smoothly. There were 3 patients with less cement leakage to vertebral disc, 5 patients at the vertebral edge, 2 patients at the spinal canal, but no clinical symptoms occured. The VAS has the statistical significant difference between before operation （7.60± 0.95）, the lth day after operation（ 1.00± 0.74） and 3 months later after operation（0.20± 0.48） （P〈0.01）. The ODI has the statistical significant difference between before operation（84.94± 4.36）%, the lth day after operation（20.47± 3.61 ）% and 3 months later after operation（9.85± 3.43）% （P〈0.01）. Conclusion： Postoperative 1 day pain and function were improved obviously than before PKP, 3 months postoperative also have further improved than postoperative 1 day. The PKP can relieve the pain and the functional disability caused by the OVCF immedi- ately, and increase the intensity of vertebral body as safety and easy-processing microinvasive treatment method. PKP has the broad ap- plication prospect.