新型二代Kyphon球囊与一代Kyphon球囊治疗骨质疏松性椎体压缩骨折的疗效对比

Clinical effects between Kyphon XpanderⅠ and Kyphon XpanderⅡ percutaneous kyphoplasty on the treatment of osteoporotic vertebral compression fractures

中文关键词:  二代Kyphon球囊  骨质疏松  椎体压缩性骨折  椎体后凸成形术  微创

英文关键词:Kyphon XpanderⅡ  Osteoporosis  Vertebral compression fracture  Percutaneous kyphonplasty  Minimally invasive surgery

中文摘要:

  【摘要】 目的：比较应用新型二代Kyphon球囊与一代Kyphon球囊行经皮球囊扩张椎体后凸成形术治疗骨质疏松性椎体压缩骨折（OVCFs）的临床疗效。方法：选取我院2015年4月~2016年4月的61例OVCFs患者共70节手术椎体进行回顾性研究，根据术中应用球囊不同分为KyphonⅠ组与KyphonⅡ组。影像学测量患者伤椎高度及Cobb角度，计算伤椎前缘高度比值及术后伤椎高度的恢复及再塌陷程度，评价伤椎的撑开效果。采用视觉模拟评分（visual analogue scale，VAS）及Oswestry功能障碍指数评分（oswestry disability index，ODI）评价患者的疼痛程度和腰椎功能。结果：KyphonⅠ组共33例患者38节手术椎体，男性9例，女性24例，年龄66.31±7.85岁；KyphonⅡ组共28例患者32节手术椎体，男性10例，女性18例，年龄68.01±8.63岁。两组患者的术前VAS评分、Cobb角、椎体高度、ODI评分、住院日、手术时间、平均单节椎体注入骨水泥量及出血量的比较均无统计学差异（P>0.05），但KyphonⅡ组术中的球囊撑开压力（374.14±165.15Psi），明显高于KyphonⅠ组（171.45±97.81Psi）（P<0.05）。两组术后1d及术后12个月的Cobb角度、伤椎前缘高度及前缘高度比值的差异具有显著统计意义（P<0.05）。此外，KyphonⅡ组术后1d伤椎提升高度与Cobb改善角度明显优于KyphonⅠ组（P<0.05）；术后12个月KyphonⅠ组Cobb角的再丢失程度较明显（P<0.05）。KyphonⅠ组出现8节椎体（21.05%）骨水泥渗漏，KyphonⅡ组出现1节椎体（3.13%）。术后邻近椎体骨折KyphonⅠ组出现3例（9.09%），KyphonⅡ组出现0例，所有并发症均未引起明显的临床症状。结论：对于伴有前壁或侧壁破裂的严重椎体压缩骨折的治疗，新型二代Kyphon球囊相比于一代Kyphon球囊的椎体撑开及稳定效果更加显著，骨水泥渗漏及邻近椎体再骨折发生率更低。

英文摘要:

  【Abstract】 Objectives: To compare the clinical efficacy of Kyphon XpanderⅡ and Kyphon XpanderⅠ on the treatment of osteoporotic vertebral compression fractures(OVCFs). Methods: A total of 61 patients and 70 surgical vertebrae accompanied with fracture anterior wall or sidewall fracture were divided into KyphonⅠ group and KyphonⅡ group based on different balloon types. The imaging parameters including vertebral height and Cobb angle, the vertebral distraction effect was assessed by calculating the ratio of anterior body and the recovery of vertebral height and the degree of posterior collapse. Visual analogue scale(VAS) and oswestry disability index(ODI) were applied to evaluate the degree of pain and function. Results: KyphonⅠ group included 33 patients and 38 vertebrae, there were 9 males and 24 females with an average age of (66.31±7.85) years old. KyphonⅡ group included 28 patients and 32 vertebrae, there were 10 males and 18 females with an average age of (68.01±8.63) years old. There was no significant difference in the clinical data between the two groups(P>0.05), and the same results were also shown in hospital stay, surgical time, cement volume and blood loss(P>0.05). But the average balloon pressure of KyphonⅡ group(374.14±165.15psi) was significantly higher than that of KyphonⅠ group(171.45±97.81psi), (P<0.05). The comparison of Cobb angle, height of anterior body and its ratio between 1d and 12m after operation was statistical different(P<0.05), but VAS and ODI score did not show obviously different(P>0.05). In addition, KyphonⅡ group also showed significant advantage at the recovery value of Cobb angel and vertebral height 1 day after operatio(P<0.05), and KyphonⅠ group was more remarkable at the degree of Cobb angle loss at 12 months after operation(P<0.05). When considering complication, 8 vertebrae(21.05%) in KyphonⅠ group and 1 vertebra(3.13%) in KyphonⅡ group were noted cement leakage respectively, and 3 adjacent vertebral fractures(9.09%) happened in KyphonⅠ group, while the number was 0 in KyphonⅡ group. All complications did not cause obvious clinical symptoms. Conclusions: For the treatment of OVCFs patients accompanied with anterior wall and sidewall fracture, the new type of Kyphon XpanderⅡ can effectively restore the vertebral height and maintain the effect, the incidence rate of cement leakage and adjacent vertebral fracture is obviously lower, which comes to the satisfying clinical efficacy.