【摘要】 目的比较经皮椎体成形术(PVP)治疗新鲜与陈旧不愈合骨质疏松性椎体压缩骨折(OVCFs)的疗效。方法 544例接受PVP手术患者,按照从受伤到手术时间的间隔将患者分为A组(新鲜骨折,<3周,456例)和B组(陈旧骨折不愈合,8~24周,88例)。采用疼痛VAS评分对患者术前、离院时、术后3个月、术后1年进行疗效评价。结果 512例患者获得为期1年的随访,随访率为94.1%,其中A组430例(492处骨折),B组82例(86处骨折)。骨水泥注射剂量:A组为3.2~8.0(5.6±0.05)ml,B组为3.0~7.6(6.0±0.04)ml,差异无统计学意义(P>0.05)。骨水泥渗漏率:A组为9.8%(42/430),B组为4.9%(4/82),差异有统计学意义(P<0.05)。VAS评分:A组术前为9.2分±0.06分,离院时为2.2分±0.07分,术后3个月时为2.3分±0.06分,术后12个月时为2.5分±0.05分,术后各时段与术前相比差异均有统计学意义(P<0.05);B组术前为8.6分±0.05分,离院时为1.0分±0.07分,3个月时为1.1分±0.04分,术后12个月时为1.1分±0.03分,术后各时段与术前相比差异均有统计学意义(P<0.05)。两组VAS评分比较:术前差异无统计学意义(P>0.05),离院时、术后3个月及术后12个月差异均有统计学意义(P<0.05)。结论 PVP通过骨水泥可以将陈旧OVCFs椎体内的假关节牢固固定,不但可以达到解除疼痛的目的,而且显著降低了骨水泥发生严重渗漏的风险,疗效优于新鲜骨折。更多还原

【Abstract】 Objective To compare the effect of fresh and delayed nonunion osteoporotic vertebral compression fractures( OVCFs) treated by PVP. Methods A total of 544 patients underwent the PVP operation,which were divided into two groups according to the duration from injury to operation,as group A( group of fresh fractures,< 3 weeks,456 cases); and group B( group of delayed nonunion fractures,8 ~ 24 weeks,88 cases). All the patients were evaluated by visual analogue scale( VAS) in the preoperation,discharge,the 3rd and 12 th month postoperatively,then the treatment effect between the two groups was compared. Results Though all the patients were followed up for one year,only 512 patients were available,the follow-up rate was 94. 1%. Group A and B were composed of 430 patients( 492 level fractures) and 82 patients( 86 level fractures) respectively. The volume of cement injection in group A and B was 3. 2 ~ 8. 0( 5. 6 ± 0. 05) ml and 3. 0 ~ 7. 6( 6. 0 ± 0. 04) ml respectively,the difference was not statistical significant( P > 0. 05). The incidence of cement leakage was 9. 8%( 42 /430) in group A and 4. 9%( 4 /82) in group B,it was of statistical significant difference( P < 0. 05). The VAS in group A was 9. 2 ± 0. 06 preoperatively,2. 2 ± 0. 07 in discharge,2. 3 ± 0. 06 and 2. 5 ± 0. 05 in the 3rd and 12 th month postoperatively,all the difference was statistical significant compared with preoperatively( P < 0. 05). The VAS in group B was 8. 6 ± 0. 05 preoperatively,1. 0 ± 0. 07 in discharge,1. 1 ± 0. 04 and 1. 1 ± 0. 03 in the 3rd and 12 th month postoperatively,all the difference was statistical significant compared with preoperatively( P < 0. 05). The difference of VAS between group A and B preoperatively was not statistical significant( P > 0. 05),but in the discharge,the 3rd and 12 th month postoperatively,the difference between the two groups was statistical significant( P < 0. 05) respectively. Conclusions The pseudoarthrosis in the nonunion OVCFs can be fixed stably with cement through the PVP procedure,which can not only relieve the pain,but reduce the incidence of cement leakage significantly,so the treatment effect is superior to the fresh OVCFs.更多还原