骨质疏松性椎体压缩骨折网袋成形是否手法复位比较△

Vesselplasty for osteoporotic vertebral compression fractures with or without manual reduction

摘要:

[目的] 比较网袋成形术 （vesselplasty, VP） 治疗骨质疏松性椎体压缩性骨折 （osteoporotic vertebral compression frac- ture, OVCF）是否手法复位的临床疗效。[方法]回顾性分析 2020 年 7 月—2022 年 4 月本院采用 VP 治疗 OVCF 65 例患者的临床资料。根据医患沟通结果， 31 例 VP 术前进行手法复位 （复位组），34 例术前未进行手法复位 （未复位组）。比较两组围手术期、随访及影像结果。[结果]所有患者手术均顺利完成，无严重并发症发生。复位组手术时间 [(31.4±6.7) min vs (38.9±13.0) min, P=0.006]、骨水泥渗漏率（22.6% vs 58.8%, P=0.003）显著优于未复位组，两组术中透视次数、骨水泥注入量、下地行走时间、住院时间、住院费用差异均无统计学意义 （P＞0.05）。所有患者均获得 1 年以上随访，两组完全负重活动时间的差异无统计学意义（P＞0.05）。术后随时间推移，VAS 和 ODI 评分均显著减少（P＜0.05），相应时间点，两组间上述指标的差异均无统计学意义 （P＞0.05）。影像方面，与术前相比，术后两组局部 Cobb 角、椎体前缘高度均显著改善 （P＜0.05），相应时间点，两组间局部 Cobb 角、椎体前缘高度的差异均无统计学意义（P＞0.05）。[结论]VP 联合手法复位在骨质疏松性椎体压缩性骨折的治疗中能更好地降低骨水泥渗漏率，缩短手术时间。

Abstract:

[Objective] To compare the clinical efficacy of vesselplasty (VP) with or without manual reduction for osteoporotic verte- bral compression fracture (OVCF). [Methods] A retrospective study was done on 65 patients who underwent VP for OVCF in our hospital from July 2020 to April 2022. According to doctor-patient communication, 31 patients had manual reduction conducted, followed by the VP (the reduction group), while the other 34 patients underwent VP without manual reduction before surgery (the non- reduction group). The documents regarding to perioperative period, follow-up and images were compared between the two groups. [Results] All patients were successfully operated on without serious complications. The reduction group proved significantly superior to the non- reduction group in terms of operation time [(31.4±6.7) min vs (38.9±13.0) min, P=0.006] and the bone cement leakage rate (22.6% vs 58.8%, P=0.003), al- though there were no significant differences in intraoperative fluoroscopy times, bone cement injection amount, postoperative ambulation time, hospital stay and hospitalization cost between the two groups (P＞0.05). All patients were followed up for more than 1 year, and there was no significant difference in the time to resume full weight-bearing activities between the two groups (P＞0.05). The VAS and ODI scores decreased significantly over time in both groups (P＜0.05), whereas which were not statistically significant between the two groups at any time points accordingly (P＞0.05). With regard of imaging, the local kyphotic Cobb angle and anterior vertebral height were significantly im- proved in both groups at the latest follow-up compared with those preoperatively (P＜0.05), however, there were no statistically significant differences in the local kyphotic Cobb angle and anterior vertebral height between the two groups at any corresponding time points (P＞ 0.05). [Conclusion] The VP combined with manual reduction does better reduce the chance of bone cement leakage, and shorten the opera- tive time in the treatment of osteoporotic vertebral compression fractures.