骨质疏松性椎体骨折不同复位程度椎体成形比较△

Comparison of different reduction heights with a reductor ahead of percutaneous vertebroplasty for osteoporotic vertebral compression fractures

摘要:

[目的]评价骨折复位器不同复位高度联合经皮椎体成形术（percutaneous vertebroplasty, PVP）治疗骨质疏松性椎体压缩性骨折 （osteoporotic vertebral compression fractures, OVCF） 的疗效。[方法] 2020 年 1 月—2021 年 12 月本院收治的 86 例单节段 OVCF 患者，随机分为 3 组。所有患者均行仰卧位复位器复位后 PVP 术，其中，低复位组 30 例，复位器高度 7~9 cm； 中复位组 29 例，高度 10~12 cm；高复位组 27 例，高度为 13~15 cm。比较三组患者的围手术期、随访和影像资料。[结果]低复位组骨水泥注入量显著少于中复位组和高复位组 [(3.4±0.9) ml vs (4.1±0.9) ml vs (3.9±1.0) ml, P=0.015]，三组间骨水泥渗漏率差异无统计学意义 （P＞0.05）。所有患者均获随访 12 个月以上，随时间推移，三组患者术后 VAS 和 ODI 评分均显著降低 （P＜ 0.05）。术前至术后 6 个月，三组间 VAS 评分的差异无统计学意义（P＞0.05），所有相应时间点，三组间 ODI 评分差异无统计学意义 （P＞0.05）。但是，末次随访时低复位组的 VAS 评分显著大于中复位组和高复位组 [(1.4±0.9) vs (0.9±0.7) vs (0.9±0.8), P= 0.020]。影像方面，随访过程中新发或再发骨折为低复位组 2 例 （6.7%），中复位组 3 例 （10.3%），高复位组 6 例 （22.2%）， 但差异无统计学意义（P＞0.05）。与术前相比，术后三组患者椎体前缘高度和局部后凸角均显著改善（P＜0.05）。术前三组间椎体前缘高度和局部后凸角的差异均无统计学意义（P＞0.05），术后相应时间点低复位组的椎体前缘高度和局部后凸 Cobb 角均显著不及中复位组及高复位组 （P＜0.05）；高复位组与中复位组间椎体前缘高度及局部 Cobb 角的差异均无统计学意义 （P＞ 0.05）。[结论]不同复位高度 PVP 治疗 OVCF 均能有效缓解疼痛，提高患者术后生活质量。采用 10 cm 以上的复位高度能够更好地恢复骨折椎体前缘高度及改善后凸畸形。

Abstract:

[Objective] To compare the clinical outcomes of different reduction heights with a self-developed reductor before percuta- neous vertebroplasty (PVP) for osteoporotic vertebral compression fracture (OVCF). [Methods] A total of 86 patients with single-segment OVCF admitted to our hospital from January 2020 to December 2021 were randomly divided into 3 groups. All patients underwent PVP af- ter fracture reduction in supine position with the self-developed reductor. Of them, 30 patients in the low reduction (LR) group received re- duction with the reductor height of 7~9 cm, 29 patients in the middle reduction (MR) group were with the height of 10~12 cm, while the re- maining 27 patients in the high reduction (HR) group were with the height of 13~15 cm. The perioperative period, follow-up and imaging data of the three groups were compared. [Results] The LR group had significantly less amount of bone cement injected in PVP than the MR and HR groups [(3.4±0.9) ml vs (4.1±0.9) ml vs (3.9±1.0) ml, P=0.015], although there was no a significant difference in bone cement leak- age rate among the three groups (P＞0.05). With time of follow-up lasted for more than 12 months, the VAS and ODI scores significantly de- creased in the three groups (P＜0.05). Nevertheless, there were no significant differences in terms of VAS scores between the three groups preoperatively to 6 months postoperatively (P＜0.05), and ODI scores at any time points accordingly (P＜0.05), the LR group proved signifi- cantly higher VAS scores than the MR and HR groups at the latest follow-up [(1.4±0.9) vs (0.9±0.7) vs (0.9±0.8), P=0.020]. Regarding to imaging, the new-onset or recurrent fractures during follow-up were found in 2 cases (6.7%) in the LR group, 3 cases (10.3%) in the MR group, and 6 cases (22.2%) in the HR group, whereas which was not statistically significant (P＞0.05). Compared with those preoperatively, the anterior vertebral height and local kyphotic Cobb angle significantly improved in all the three groups postoperatively (P＜0.05). There were no significant differences in anterior vertebral height and local kyphotic Cobb angle among the three groups before surgery (P＞0.05), whereas the LR group proved significantly inferior to the MR and HR groups in abovementioned items at all corresponding time points after surgery (P＜0.05). However, there were no significant differences in the anterior vertebral height and the local kyphotic Cobb Angle between the MR and HR groups postoperatively (P＞0.05). [Conclusion] PVP after fracture reduction in different heights does effectively relieve pain and improve postoperative quality of life for OVCF. By comparison, the reduction height in more than 10cm does better restore the an- terior vertebral height of the fractured vertebra and improve the kyphosis.