经皮椎体支架成形术治疗骨质疏松性椎体压缩骨折

Percutaneous vertebral body stents for osteoporotic vertebral compression fractures

摘要:

［目的］ 与椎体后凸成形术 （percutaneous kyphoplasty, PKP） 比较，评价经皮椎体支架系统 （vertebral body stent, VBS） 治疗骨质疏松椎体压缩骨折 （osteoporotic vertebral compression fracture, OVCF） 的临床疗效。［方法］ 2019 年 1 月—2020 年 1 月收治的 62 例 OVCF 患者纳入本研究，依据术前医患沟通结果将患者分为两组。其中，30 例行 VBS 治疗（VBS 组），32 例行 PKP 治疗（PKP 组）。比较两组围手术期、随访与影像资料。［结果］62 例患者均顺利完成手术。骨水泥渗漏 VBS 组为 4/ 30 （13.33%），PKP 组为 10/32 （31.25%），两组间差异无统计学意义 （P>0.05）。术中球囊破裂 VBS 组为 5/60 （8.33%），PKP 组为 0/64 （0%），差异有统计学意义 （P<0.05）。两组患者手术时间、术中透视时间、骨水泥注入量、术后下地时间和住院时间的差异无统计学意义（P>0.05）。所有患者均获随访 12~16 个月，平均（14.11±1.29）个月。VBS 组恢复伤前负重活动显著早于 PKP 组（P<0.05）。与术前相比，末次随访时两组患者 VAS 和 ODI 评分均显著下降（P<0.05）。相应时间点，两组间 VAS 和 ODI 评分的差异均无统计学意义 （P>0.05）。影像方面，与术前相比，末次随访时两组患者椎体相对高度均显著增加 （P< 0.05），而局部 Cobb 角均显著下降 （P<0.05）。末次随访时，VBS 组在椎体相对高度和局部 Cobb 角均显著优于 PKP 组 （P< 0.05）。［结论］对 OVCF 治疗，VBS 在矫正椎骨畸形方面明显优于 PKP。

Abstract:

[Objective] To evaluate the clinical outcome of percutaneous vertebral body stent (VBS) for osteoporotic vertebral compres- sion fracture (OVCF) , by comparison with percutaneous kyphoplasty (PKP) . [Methods] A total of 62 patients admitted our hospital from January 2019 to January 2020 for OVCF were included into this study, and divided into two groups based on results of preoperative doctorpatient communication. Among them, 30 patients received VBS, while the remaining 32 patients underwent PKP. The perioperative, followup and imaging data were compared between the two groups. [Results] All the 62 patients had corresponding surgical procedures completed successfully. The bone cement leakage was of 4/30 (13.33%) in the VBS group, whereas 10/32 (31.25%) in the PKP group, which was not statistically significant between the two groups (P＞0.05) . Intraoperative balloon rupture was of 5/60 (8.33%) in the VBS group, whereas 0/ 64 (0%) in the PKP group, with a statistically significant difference (P＜0.05) . There was no significant difference between the two groups in terms of operation time, intraoperative fluoroscopy, bone cement injection volume, postoperative ambulation time and hospital stay (P＞ 0.05) . All the patients were followed up for 12~16 months, with an average of (14.11±1.29) months. The VBS group resumed the level of pre-injury weight-bearing activity significantly earlier than the PKP group (P＜0.05) . The VAS and ODI scores significantly decreased at the latest follow-up compared with those preoperatively in both groups (P＜0.05) . However, the differences in VAS and ODI scores at the corresponding time points were not statistically significant between the two groups (P＞0.05) . Regarding to imaging assessment, the relative vertebral height increased significantly (P＜0.05) , while the local Cobb angle decreased significantly (P＜0.05) in both groups at the latest follow-up compared with those preoperatively. The VBS group was significantly superior to the PKP group in terms of the relative height of the vertebral body and the local Cobb angle at the latest follow-up (P＜0.05) . [Conclusion] For OVCF treatment, the VBS is considerably better than PKP in correcting vertebral deformities.