非手术与手术治疗胸腰椎骨质疏松骨折的疗效观察
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摘要
目的比较非手术与经皮椎体成形术(PVP)治疗新鲜胸腰椎骨质疏松骨折的临床疗效。方法回顾性分析2016年1月至2017年3月我院收治的201例胸腰椎骨质疏松骨折患者的临床资料,其中非手术治疗48例(保守组),行PVP治疗153例(手术组)。对比2组患者的治疗费用及治疗后1周、1个月、3个月、6个月及12个月的VAS评分、Oswestry功能障碍指数(ODI评分)、治疗后12个月椎体前缘高度丢失率、后凸Cobb角的变化情况。结果所有患者随访12～21个月,平均13. 7个月。保守组患者未出现卧床相关并发症,手术组出现1例骨水泥渗漏至椎管。在治疗后1周、1个月,保守组VAS评分较手术组高,差异有统计学意义(P <0. 05);治疗后3个月,2组VAS评分差异无统计学意义(P> 0. 05)。治疗后1周、1个月、3个月,保守组ODI评分较手术组高,差异有统计学意义(P <0. 05);治疗后6个月,2组ODI评分差异无统计学意义(P> 0. 05)。治疗后12个月保守组椎体前缘高度丢失率及后凸角较手术组大,差异有统计学意义(P <0. 05)。保守组治疗费用较手术组低,差异具有统计学意义(P <0. 05)。结论非手术治疗可改善胸腰椎骨质疏松性骨折引起的疼痛和残疾,与PVP相比,症状缓解较慢,但风险低,患者经济负担小,是安全有效的治疗方法。
Objective To compare the clinical efficacy of non-surgical and percutaneous vertebroplasty( PVP) in the treatment of fresh osteoporotic thoracolumbar fractures. Methods A total of 201 patients with osteoporotic fractures of the thoracolumbar spine from January2016 to March 2017 in our hospital were retrospectively analyzed. Of whom 48 cases received non-surgical treatments( conservative group)and 153 patients treated with PVP( surgery group). The treatment costs,the VAS of the two groups in 1 week,1 months,3 months,6 months and 12 months after treatment,Oswestry disability index( ODI),vertebral body height loss and kyphotic Cobb angle in 12 months after treatment between two groups were compared. Results All patients were followed up for 12 to 21 months with an average of 13. 7 months. There was no complication in the conservative group,while there was 1 case with bone cement leakage into spinal canal. The VAS score of conservative group was more than that of surgery group in 1 week and 1 month after treatment,the difference was significant( P < 0. 05). There was no significant difference in VAS score between the two groups after 3 months of treatment( P > 0. 05). The ODI scores of conservative group were more than those of surgery group after 1 week,1 months and 3 months of treatment,the differences were significant( P < 0. 05). There was no significant difference in ODI scores between the two groups after 6 months of treatment. After 12 months,the height loss rate and kyphosis of the vertebral body in the conservative group were larger than those in the surgery group,and the differences were statistically significant( P < 0. 05). The cost of treatment in the conservative group was less than that in the surgery group,the difference was statistically significant( P < 0. 05). Conclusion Non-surgical treatment can improve the pain and disability caused by osteoporotic fracture of thoracolumbar spine,with slowly relief of symptoms,lower risk and the less cost for patient compared with PVP. It is a safe and effective treatment.
Objective To compare the clinical efficacy of non-surgical and percutaneous vertebroplasty( PVP) in the treatment of fresh osteoporotic thoracolumbar fractures. Methods A total of 201 patients with osteoporotic fractures of the thoracolumbar spine from January2016 to March 2017 in our hospital were retrospectively analyzed. Of whom 48 cases received non-surgical treatments( conservative group)and 153 patients treated with PVP( surgery group). The treatment costs,the VAS of the two groups in 1 week,1 months,3 months,6 months and 12 months after treatment,Oswestry disability index( ODI),vertebral body height loss and kyphotic Cobb angle in 12 months after treatment between two groups were compared. Results All patients were followed up for 12 to 21 months with an average of 13. 7 months. There was no complication in the conservative group,while there was 1 case with bone cement leakage into spinal canal. The VAS score of conservative group was more than that of surgery group in 1 week and 1 month after treatment,the difference was significant( P < 0. 05). There was no significant difference in VAS score between the two groups after 3 months of treatment( P > 0. 05). The ODI scores of conservative group were more than those of surgery group after 1 week,1 months and 3 months of treatment,the differences were significant( P < 0. 05). There was no significant difference in ODI scores between the two groups after 6 months of treatment. After 12 months,the height loss rate and kyphosis of the vertebral body in the conservative group were larger than those in the surgery group,and the differences were statistically significant( P < 0. 05). The cost of treatment in the conservative group was less than that in the surgery group,the difference was statistically significant( P < 0. 05). Conclusion Non-surgical treatment can improve the pain and disability caused by osteoporotic fracture of thoracolumbar spine,with slowly relief of symptoms,lower risk and the less cost for patient compared with PVP. It is a safe and effective treatment.
引文
[1]马远征,王以朋,刘强,等.中国老年骨质疏松症诊疗指南(2018)[J].中国骨质疏松杂志,2018,24(12):1541-1567.doi:10.3969/j.issn.1006-7108.2018.12.001.
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[3]Tsujio T,Nakamura H,Terai H,et al.Characteristic radiographic or magnetic resonance images of fresh osteoporotic vertebral fractures predicting potential risk for nonunion[J].Spine,2011,36(15):1229-1235.doi:10.1097/brs.0b013e3181f29e8d.
[4]印平,马远征,马迅,等.骨质疏松性椎体压缩性骨折的治疗指南[J].中国骨质疏松杂志,2015,21(6):643-648.doi:10.3969/j.issn.1006-7108.2015.06.001.
[5]中华医学会骨质疏松和骨矿盐疾病分会.骨质疏松性骨折患者抗骨质疏松治疗与管理专家共识[J].中华骨质疏松和骨矿盐疾病杂志,2015,8(3):189-195.doi:10.3969/j.issn.1674-2591.2015.03.001.
[6]中华医学会骨科学分会骨质疏松学组.骨质疏松性骨折诊疗指南[J].中华骨科杂志,2017,37(1):1-10.doi:10.3760/cma.j.issn.0253-2352.2017.01.001.
[7]《中国老年骨质疏松症诊疗指南(2018)》工作组,中国老年学和老年医学学会骨质疏松分会,马远征,等.中国老年骨质疏松症诊疗指南(2018)[J].中华健康管理学杂志,2018,12(6):484-509.doi:10.3969/j.issn.1006-7108.2018.12.001.
[8]Yuan WH,Hsu HC,Lai KL.Vertebroplasty and balloon kyphoplasty versus conservative treatment for osteoporotic vertebral compression fractures:a meta-analysis[J].Medicine,2016,95(31):e4491.doi:10.1097/MD.0000000000004491.
[9]Jin C,Xu G,Weng D,et al.Impact of magnetic resonance imaging on treatment-related decision making for osteoporotic vertebral compression fracture:a prospective randomized trial[J].Med Sci Monit,2018,24:50-57.doi:10.12659/MSM.905729.
[10]Shi MM,Cai XZ,Lin T,et al.Is there really no benefit of vertebroplasty for osteoporotic vertebral fractures?A meta-analysis[J].Clin Orthop Relat Res,2012,470(10):2785-2799.doi:10.1007/s11999-012-2404-6.
[11]Sun ZY,Li XF,Zhao H,et al.Percutaneous balloon kyphoplasty in treatment of painful osteoporotic occult vertebral fracture:a retrospective study of 89 cases[J].Med Sci Monit,2017,23:1682-1690.doi:10.12659/MSM.903997.
[12]杨惠林.经皮椎体强化术的临床应用[J].骨科,2017,8(3):161-162.doi:10.3969/j.issn.1674-8573.2017.03.001
[13]Buchbinder R,Johnston RV,Rischin KJ,et al.Percutaneous vertebroplasty for osteoporotic vertebral compression fracture[J].Cochrane Database Syst Rev,2018,11(4):CD006349.doi:10.1002/14651858.CD006349.pub3.
[14]Hazzard MA,Huang KT,Toche UN,et al.Comparison of vertebroplasty,kyphoplasty,and nonsurgical management of vertebral compression fractures and impact on US Healthcare Resource Utilization[J].Asian Spine J,2014,8(5):605-614.doi:10.4184/asj.2014.8.5.605.
[15]Abe T,Shibao Y,Takeuchi Y,et al.Initial hospitalization with rigorous bed rest followed by bracing and rehabilitation as an option of conservative treatment for osteoporotic vertebral fractures in elderly patients:a pilot one arm safety and feasibility study[J].Arch Osteoporos,2018,13(1):134.doi:10.1007/s11657-018-0547-0.
[16]Firanescu CE,Vries JD,Lodder P,et al.Vertebroplasty versus sham procedure for painful acute osteoporotic vertebral compression fractures(VERTOS IV):randomised sham controlled clinical trial[J].BMJ,2018,361:k1551.doi:10.1136/bmj.k1551.
[17]Siddharth S,Goregaonkar AB.Conservative management of osteoporotic vertebral fractures:a prospective study of thirty patients[J].Cureus,2016,8(3):e542.doi:10.7759/cureus.542.
[18]Blattert TR,Schnake KJ,Oliver G,et al.Nonsurgical and surgical management of osteoporotic vertebral body fractures:recommendations of the spine section of the german society for orthopaedics and trauma(DGOU)[J].Global Spine J,2018,8(2_suppl):50S-55S.doi:10.1177/2192568217745823.
[19]Robert MG.AAOS clinical practice guideline:the treatment of symptomatic osteoporotic spinal compression fractures[J].J Am Acad Orthop Surg,2011,19(3):183-184.doi:10.5435/00124635-201103000-00007.
[20]Pcs P,Maher CG,Megale RZ,et al.An overview of clinical guidelines for the management of vertebral compression fracture:a systematic review[J].Spine J,2017,17(12):1932-1938.doi:10.1016/j.spinee.2017.07.174.
[2]Si L,Winzenberg TM,Jiang Q,et al.Projection of osteoporosis-related fractures and costs in China:2010-2050[J].Osteoporos Int,2015,26(7):1929-1937.doi:10.3969/j.issn.1674-2591.2015.03.001.
[3]Tsujio T,Nakamura H,Terai H,et al.Characteristic radiographic or magnetic resonance images of fresh osteoporotic vertebral fractures predicting potential risk for nonunion[J].Spine,2011,36(15):1229-1235.doi:10.1097/brs.0b013e3181f29e8d.
[4]印平,马远征,马迅,等.骨质疏松性椎体压缩性骨折的治疗指南[J].中国骨质疏松杂志,2015,21(6):643-648.doi:10.3969/j.issn.1006-7108.2015.06.001.
[5]中华医学会骨质疏松和骨矿盐疾病分会.骨质疏松性骨折患者抗骨质疏松治疗与管理专家共识[J].中华骨质疏松和骨矿盐疾病杂志,2015,8(3):189-195.doi:10.3969/j.issn.1674-2591.2015.03.001.
[6]中华医学会骨科学分会骨质疏松学组.骨质疏松性骨折诊疗指南[J].中华骨科杂志,2017,37(1):1-10.doi:10.3760/cma.j.issn.0253-2352.2017.01.001.
[7]《中国老年骨质疏松症诊疗指南(2018)》工作组,中国老年学和老年医学学会骨质疏松分会,马远征,等.中国老年骨质疏松症诊疗指南(2018)[J].中华健康管理学杂志,2018,12(6):484-509.doi:10.3969/j.issn.1006-7108.2018.12.001.
[8]Yuan WH,Hsu HC,Lai KL.Vertebroplasty and balloon kyphoplasty versus conservative treatment for osteoporotic vertebral compression fractures:a meta-analysis[J].Medicine,2016,95(31):e4491.doi:10.1097/MD.0000000000004491.
[9]Jin C,Xu G,Weng D,et al.Impact of magnetic resonance imaging on treatment-related decision making for osteoporotic vertebral compression fracture:a prospective randomized trial[J].Med Sci Monit,2018,24:50-57.doi:10.12659/MSM.905729.
[10]Shi MM,Cai XZ,Lin T,et al.Is there really no benefit of vertebroplasty for osteoporotic vertebral fractures?A meta-analysis[J].Clin Orthop Relat Res,2012,470(10):2785-2799.doi:10.1007/s11999-012-2404-6.
[11]Sun ZY,Li XF,Zhao H,et al.Percutaneous balloon kyphoplasty in treatment of painful osteoporotic occult vertebral fracture:a retrospective study of 89 cases[J].Med Sci Monit,2017,23:1682-1690.doi:10.12659/MSM.903997.
[12]杨惠林.经皮椎体强化术的临床应用[J].骨科,2017,8(3):161-162.doi:10.3969/j.issn.1674-8573.2017.03.001
[13]Buchbinder R,Johnston RV,Rischin KJ,et al.Percutaneous vertebroplasty for osteoporotic vertebral compression fracture[J].Cochrane Database Syst Rev,2018,11(4):CD006349.doi:10.1002/14651858.CD006349.pub3.
[14]Hazzard MA,Huang KT,Toche UN,et al.Comparison of vertebroplasty,kyphoplasty,and nonsurgical management of vertebral compression fractures and impact on US Healthcare Resource Utilization[J].Asian Spine J,2014,8(5):605-614.doi:10.4184/asj.2014.8.5.605.
[15]Abe T,Shibao Y,Takeuchi Y,et al.Initial hospitalization with rigorous bed rest followed by bracing and rehabilitation as an option of conservative treatment for osteoporotic vertebral fractures in elderly patients:a pilot one arm safety and feasibility study[J].Arch Osteoporos,2018,13(1):134.doi:10.1007/s11657-018-0547-0.
[16]Firanescu CE,Vries JD,Lodder P,et al.Vertebroplasty versus sham procedure for painful acute osteoporotic vertebral compression fractures(VERTOS IV):randomised sham controlled clinical trial[J].BMJ,2018,361:k1551.doi:10.1136/bmj.k1551.
[17]Siddharth S,Goregaonkar AB.Conservative management of osteoporotic vertebral fractures:a prospective study of thirty patients[J].Cureus,2016,8(3):e542.doi:10.7759/cureus.542.
[18]Blattert TR,Schnake KJ,Oliver G,et al.Nonsurgical and surgical management of osteoporotic vertebral body fractures:recommendations of the spine section of the german society for orthopaedics and trauma(DGOU)[J].Global Spine J,2018,8(2_suppl):50S-55S.doi:10.1177/2192568217745823.
[19]Robert MG.AAOS clinical practice guideline:the treatment of symptomatic osteoporotic spinal compression fractures[J].J Am Acad Orthop Surg,2011,19(3):183-184.doi:10.5435/00124635-201103000-00007.
[20]Pcs P,Maher CG,Megale RZ,et al.An overview of clinical guidelines for the management of vertebral compression fracture:a systematic review[J].Spine J,2017,17(12):1932-1938.doi:10.1016/j.spinee.2017.07.174.