椎体后凸成形术联合小关节突封闭治疗单节段椎体压缩性骨折的临床疗效
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摘要
目的探讨经皮穿刺椎体后凸成形术(PKP)联合小关节突封闭治疗老年单节段椎体压缩性骨折的临床效果。方法收集2018年1月至2019年1月我院收治的单节段椎体压缩性骨折患者72例,按手术方式的不同分为对照组和观察组,分别行单纯PKP和PKP联合小关节突封闭手术。应用疼痛视觉模拟指数VAS评分、功能障碍指数ODI评分分别评估患者术前、术后即刻、术后24 h、术后72 h、术后1个月临床疗效。结果观察组患者手术时间长于对照组,差异有统计学意义(P <0. 05); 2组患者术前VAS及ODI评分比较差异无统计学意义(P> 0. 05),术后各时间点VAS及ODI评分与术前相比均获得明显改善,差异有统计学意义(P <0. 05),观察组患者在术后即刻、术后24 h、术后72 h改善较对照组明显,差异有统计学意义(P <0. 01),但2组术后1个月VAS及ODI评分比较,差异无统计学意义(P> 0. 05)。结论 PKP联合小关节突封闭治疗老年人群单节段椎体压缩性骨折早期疼痛缓解程度更好,能更早下地活动,明显提高患者手术疗效,减少并发症。
Objective To compare the clinical outcomes of percutaneous kyphoplasty( PKP) combined with facet joint blocking in the treatment of elderly single-segment vertebral compression fracture. Methods A total of 72 patients with single-segment vertebral compression fractures who were diagnosed in our hospital from January 2018 to January 2019 were randomly divided into the control group and the observation group. PKP and PKP combined with small facet joints were performed in control group and observation group respectively. The pain visual analogue index VAS score and dysfunction index ODI score were used to evaluate the clinical efficacy in preoperative,postoperative immediately,24 hours,72 hours and 1 month. Results The operation time of the observation group was longer than that of the control group,the difference was statistically significant( P < 0. 05). There was no significant difference between the two groups in the VAS and ODI scores before operation( P > 0. 05). The VAS and ODI scores were significantly improved compared with those before operation at all postoperative time points,and the difference was statistically significant( P < 0. 05). The improvement of the observation group was more obvious at postoperative immediately,24 hours and 72 hours than those of control group,the difference was statistically significant( P < 0. 01),but there was no significant difference between the two groups at 1 month after surgery( P > 0. 05). Conclusion PKP combined with facet joint blocking for the treatment of single-segment vertebral compression fractures in the elderly has better relief of early pain,with the activity earlier,which can significantly improve the surgical outcome and reduce complications.
Objective To compare the clinical outcomes of percutaneous kyphoplasty( PKP) combined with facet joint blocking in the treatment of elderly single-segment vertebral compression fracture. Methods A total of 72 patients with single-segment vertebral compression fractures who were diagnosed in our hospital from January 2018 to January 2019 were randomly divided into the control group and the observation group. PKP and PKP combined with small facet joints were performed in control group and observation group respectively. The pain visual analogue index VAS score and dysfunction index ODI score were used to evaluate the clinical efficacy in preoperative,postoperative immediately,24 hours,72 hours and 1 month. Results The operation time of the observation group was longer than that of the control group,the difference was statistically significant( P < 0. 05). There was no significant difference between the two groups in the VAS and ODI scores before operation( P > 0. 05). The VAS and ODI scores were significantly improved compared with those before operation at all postoperative time points,and the difference was statistically significant( P < 0. 05). The improvement of the observation group was more obvious at postoperative immediately,24 hours and 72 hours than those of control group,the difference was statistically significant( P < 0. 01),but there was no significant difference between the two groups at 1 month after surgery( P > 0. 05). Conclusion PKP combined with facet joint blocking for the treatment of single-segment vertebral compression fractures in the elderly has better relief of early pain,with the activity earlier,which can significantly improve the surgical outcome and reduce complications.
引文
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[9]杨建平,王利明,孙强,等.椎体成形术与椎体后凸成形术治疗椎体压缩性骨折的疗效比较[J].中国脊柱脊髓杂志,2007,17(11):838-841.
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[11]Yang EZ,Xu JG,Huang GZ,et al. Percutaneous vertebroplasty versus conservative treatment in aged patients with acute osteoporotic vertebral compression fractures:a prospective randomized controlled clinical study[J]. Spine(Phila Pa 1976),2016,41(8):653-660. doi:10.1097/BRS. 0000000000001298.
[12]Zhang J,Fan Y,He X,et al. Bracing after percutaneous vertebroplasty for thoracolumbar osteoporotic vertebral compression fractures was not effective[J]. Clin Interv Aging,2019,14:265. doi:10. 2147/CIA.S192821.
[13]Pan M,Pi A,Xin Z,et al. Clinical observation of buyang huanwu tang combined with acupuncture in treating elderly patients with residual pain after osteoporosis thoracolumbar vertebral compression fractures operation[J]. J New Chin Med,2017(7):39.
[14]何飞宇,石磊,陈海,等.腰椎小关节骨性关节炎的病理学及影像学对比研究[J].创伤外科杂志,2012,14(3):247-249. doi:10. 3969/j. issn. 1009-4237. 2012. 03. 018.
[15]Zhang S,Zhao E,Winkelstein BA. A nociceptive role for integrin signaling in pain after mechanical injury to the spinal facet capsular ligament[J]. Ann Biomed Eng,2017,45(12):2813-2825. doi:10.1007/s10439-017-1917-2.
[16]Manchikanti L,Nampiaparampil DE,Manchikanti KN,et al. Comparison of the efficacy of saline,local anesthetics,and steroids in epidural and facet joint injections for the management of spinal pain:a systematic review of randomized controlled trials[J]. Surg Neurol Int,2015,6(Suppl 4):S194. doi:10. 4103/2152-7806. 156598.
[17]Park KD,Jee H,Nam HS,et al. Effect of medial branch block in chronic facet joint pain for osteoporotic compression fracture:one year retrospective study[J]. Ann Rehabil Med.,2013,37(2):191. doi:10.5535/arm. 2013. 37. 2. 191.
[18]Li Y,Huang M,Chen J,et al. The impact of facet joint violation on clinical outcomes after percutaneous kyphoplasty for osteoporotic vertebral compression fractures[J]. World Neurosurg,2018,119:e383-e388. doi:10. 1016/j. wneu. 2018. 07. 170.
[19]Gao C,Zong M,Wang W,et al. Analysis of risk factors causing shortterm cement leakages and long-term complications after percutaneous kyphoplasty for osteoporotic vertebral compression fractures[J]. Acta Radiol,2018,59(5):577-585. doi:10. 1177/0284185117725368.
[20]Zhong R,Jiang W,Xiong S,et al. Comparison between curved and unipedicular approach vertebroplasty for treatment of osteoporotic vertebral compression fractures[J]. Chin J Trauma,2018,34(2):102-108.
[2]Hu CH,Li QP,Wang C,et al. Analysis of clinical effects of three operative methods for osteoporotic vertebral compression fracture[J]. Zhongguo Gu Shang,2016,29(7):619-624. doi:10. 3969/j. issn. 1003-0034. 2016. 07. 007.
[3]Zuo XH,Zhu XP,Bao HG,et al. Network meta-analysis of percutaneous vertebroplasty,percutaneous kyphoplasty,nerve block,and conservative treatment for nonsurgery options of acute/subacute and chronic osteoporotic vertebral compression fractures(OVCFs)in short-term and longterm effects[J]. Medicine,2018,97(29):e11544. doi:10. 1097/MD.0000000000011544.
[4]Kim TK,Kim KH,Kim CH,et al. Percutaneous vertebroplasty and facet joint block[J]. J Korean Med Sci,2005,20(6):1023-1028. doi:10.3346/jkms. 2005. 20. 6. 1023.
[5]李锋,宋跃明,方忠,等.脊柱小关节骨关节炎诊治专家共识[J].骨科,2018,9(6):417-422.
[6]Jensen ME,Mc Graw JK,Cardella JF,et al. Position statement on percutaneous vertebral augmentation:a consensus statement developed by the American society of interventional and therapeutic neuroradiology,society of interventional radiology,American association of neurological surgeons/congress of neurological surgeons,and American society of spine radiology[J]. J Neurointerv Surg,2009,1(2):181-185. doi:10.1016/j. jvir. 2009. 04. 022.
[7]Voormolen MHJ,Mali W,Lohle PNM,et al. Percutaneous vertebroplasty compared with optimal pain medication treatment:short-term clinical outcome of patients with subacute or chronic painful osteoporotic vertebral compression fractures. The VERTOS study[J]. AJNR Am J Neuroradiol,2007,28(3):555-560.
[8]左如俊,黄承,蒋毅,等.不同方式骨水泥强化椎弓根螺钉对老年骨质疏松性胸腰椎骨折预后的影响[J].局解手术学杂志,2018,27(4):293-296. doi:10. 11659/jjssx. 07E017007.
[9]杨建平,王利明,孙强,等.椎体成形术与椎体后凸成形术治疗椎体压缩性骨折的疗效比较[J].中国脊柱脊髓杂志,2007,17(11):838-841.
[10]Liu J,Hao S,Liu Z,et al. Percutaneous kyphoplasty treatment of osteoporotic vertebral compression fracture under the guidance of G-arm Xray machine[J]. Clin Med Chin,2018,34(6):520-523.
[11]Yang EZ,Xu JG,Huang GZ,et al. Percutaneous vertebroplasty versus conservative treatment in aged patients with acute osteoporotic vertebral compression fractures:a prospective randomized controlled clinical study[J]. Spine(Phila Pa 1976),2016,41(8):653-660. doi:10.1097/BRS. 0000000000001298.
[12]Zhang J,Fan Y,He X,et al. Bracing after percutaneous vertebroplasty for thoracolumbar osteoporotic vertebral compression fractures was not effective[J]. Clin Interv Aging,2019,14:265. doi:10. 2147/CIA.S192821.
[13]Pan M,Pi A,Xin Z,et al. Clinical observation of buyang huanwu tang combined with acupuncture in treating elderly patients with residual pain after osteoporosis thoracolumbar vertebral compression fractures operation[J]. J New Chin Med,2017(7):39.
[14]何飞宇,石磊,陈海,等.腰椎小关节骨性关节炎的病理学及影像学对比研究[J].创伤外科杂志,2012,14(3):247-249. doi:10. 3969/j. issn. 1009-4237. 2012. 03. 018.
[15]Zhang S,Zhao E,Winkelstein BA. A nociceptive role for integrin signaling in pain after mechanical injury to the spinal facet capsular ligament[J]. Ann Biomed Eng,2017,45(12):2813-2825. doi:10.1007/s10439-017-1917-2.
[16]Manchikanti L,Nampiaparampil DE,Manchikanti KN,et al. Comparison of the efficacy of saline,local anesthetics,and steroids in epidural and facet joint injections for the management of spinal pain:a systematic review of randomized controlled trials[J]. Surg Neurol Int,2015,6(Suppl 4):S194. doi:10. 4103/2152-7806. 156598.
[17]Park KD,Jee H,Nam HS,et al. Effect of medial branch block in chronic facet joint pain for osteoporotic compression fracture:one year retrospective study[J]. Ann Rehabil Med.,2013,37(2):191. doi:10.5535/arm. 2013. 37. 2. 191.
[18]Li Y,Huang M,Chen J,et al. The impact of facet joint violation on clinical outcomes after percutaneous kyphoplasty for osteoporotic vertebral compression fractures[J]. World Neurosurg,2018,119:e383-e388. doi:10. 1016/j. wneu. 2018. 07. 170.
[19]Gao C,Zong M,Wang W,et al. Analysis of risk factors causing shortterm cement leakages and long-term complications after percutaneous kyphoplasty for osteoporotic vertebral compression fractures[J]. Acta Radiol,2018,59(5):577-585. doi:10. 1177/0284185117725368.
[20]Zhong R,Jiang W,Xiong S,et al. Comparison between curved and unipedicular approach vertebroplasty for treatment of osteoporotic vertebral compression fractures[J]. Chin J Trauma,2018,34(2):102-108.