PVP与保守方法治疗骨质疏松性胸腰椎椎体压缩骨折的疗效比较

Percutaneous vertebroplasty vs conservative treatment for osteoporotic thoracolumbar vertebral fractures: a comparative study

中文关键词:  椎体骨折  经皮椎体成形术  保守治疗  骨质疏松  对照研究

英文关键词:Vertebral fracture  Percutaneous vertebroplasty  Conservative management  Osteoporosis  Comparative study

中文摘要:

  【摘要】 目的：比较PVP与保守方法治疗胸腰椎骨质疏松性椎体压缩骨折（OVCF）患者的疗效。方法：2009年12月~2011年8月来我院诊治且符合研究标准的胸腰椎OVCF患者共72例，纳入标准：影像表现与临床特征完全吻合，年龄≥55岁，视觉疼痛评分（VAS）≥6分，病程在6周以内；排除标准：其他病变导致的椎体骨折或背部疼痛无法排除其他病变所致者，有中风、痴呆、恶性肿瘤、严重心肺疾病、长期服用类固醇激素者，全身或穿刺局部感染者，椎体压缩75%以上者，无法纠正的凝血功能障碍者。根据患者意愿进行前瞻性分组，PVP组39例，行PVP治疗；保守治疗组33例，采用保守治疗。两组年龄、性别、体重、病程、未骨折椎体CT值、骨折椎体数目、骨折椎体水平和治疗前骨折椎体压缩程度、VAS和Oswestry功能障碍指数（ODI）评分均无统计学差异（P＞0.05）。于治疗后1周和1、3、6、12及24个月时进行VAS和ODI评分，并进行组内和组间比较。结果：保守治疗组2例患者因止痛效果不佳而分别于治疗后2周、3周改行PVP治疗，数据纳入PVP组。两组患者均完成了治疗后6个月的随访，PVP组完成12、24个月随访的病例数分别为33、10例，保守治疗组分别为28、12例。治疗后1周PVP组的VAS、ODI评分与治疗前比较明显降低（P＜0.05）；保守治疗组治疗后1周VAS、ODI评分与治疗前比较无明显改善（P＞0.05），治疗后1个月VAS、ODI评分与治疗前比较明显降低（P＜0.05）。PVP组治疗后1周和1、3、6、12个月时的VAS、ODI评分均优于保守组（P＜0.05）；24个月时评分两组间无统计学差异（P＞0.05），但PVP组的无痛患者比例（9/10，90.0%）明显高于保守组（8/12，66.7%）。PVP组与保守治疗组患者在随访期内分别出现1例1节和2例3节新发椎体骨折。结论：PVP和保守方法治疗胸腰椎OVCF均有效，但和保守治疗方法相比，PVP可快速改善OVCF患者的疼痛及生活质量。

英文摘要:

  【Abstract】 Objectives: To prospectively compare the clinical outcome of painful osteoporotic thoracolumbar vertebral compression fractures(VCF) treated by percutaneous vertebroplasty(PVP) or conservative management. Methods: 72 consecutive patients aged 55 years or older from December 2009 to August 2011 in our hospital were enrolled in this study. All patients suffered from vertebral compression fracture evidenced bone oedema on MRI, and the VAS score was ≥6 and lasted for 6 weeks or less. The exclusion criteria included other unclear spinal disorders, history of stroke, senile dementia, malignancy, long-term oral corticosteroid use, major medical diseases requiring intensive treatment, metastatic spinal tumor, myeloma, hemangioma or infection, residual vertebral height less than 25% and noncorrectable coagulopathy. Patients were allocated to PVP group(n=39) or conservative treatment group(n=33) according to patients′ desire. VAS for pain and Oswestry disability index(ODI) questionnaire scores were assessed and compared before treatment and at 1 week, 1, 3, 6, 12 and 24 months after treatment. The patient age, sex, body weight, duration of VCF(s), vertebral levels, the loss of vertebral height, CT value of nonfractured vertebrae, number of VCF(s), VAS and ODI scores between the two groups were documented and compared. Results: Two patients with continued pain transferred to PVP group after 2 and 3 weeks′ conservative therapy. Both PVP and conservative treatment provided pain relief or physical function improvement. All the patients in both PVP and conservative treatment groups completed the 6-month follow-up period. There were 33 and 10 patients in PVP group and 28 and 12 in conservative treatment group who completed the 12 or 24-month follow-up period, respectively. VAS and ODI scores decreased significantly(P<0.05) in PVP at 1 week, but those in conservative group decreased significantly at 1 month after treatment. VAS and ODI score decreased more significantly in PVP group at 1 week and at 1, 3, 6 and 12 months compared with conservative group(all P<0.05), while no statistical significance was noted between two groups with respect to VAS and ODI scores at 24 months, but the percentage(9/10, 90.0%) of no pain cases in PVP group was higher than that in conservative group(8/12, 66.7%). One patient in PVP group and two patients in conservative group had 1 and 3 onset vertebral fracture respectively. Conclusions: Both PVP and conservative treatment are effective for the painful osteoporotic thoracolumbar VCFs. PVP has immediate pain relief and functional improvement compared with conservative treatment.