经皮椎体成形术治疗转移性肿瘤性和骨质疏松性椎体压缩骨折的临床疗效分析
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摘要
目的：回顾性对比分析经皮椎体成形术治疗椎体转移性肿瘤性和骨质疏松性椎体压缩骨折的临床疗效。
方法：选择随访2007年1月至2011年1月因椎体压缩骨折接受经皮椎体成形术治疗的患者共95例，采用问卷调查方式，通过电话、信函及门诊复查完成疗效评估资料的收集。根据导致椎体压缩骨折的病因，将患者分为A组：椎体转移性肿瘤组和B组：骨质疏松组。采用平林冽法改善率评定标准及VAS、JOA、SF-36评分标准和影像学分别评估，将所调查的数据经统计学处理，分析比较组内/组间疗效、影像学变化特点；并分析骨水泥注入量与VAS评分相关性。
结果：1.两组患者的临床疗效根据平林冽法改善率评定标准，骨质疏松组优良率与椎体转移性肿瘤组比较有显著性差异（P＜0.01）。
2．两组术后VAS、JOA、SF-36评分及疼痛缓解程度，骨质疏松组与肿瘤组比较有显著性差异(P＜0.05)。
3．两组术后椎体前缘、中部高度，术后Cobb角与术前比较，椎体高度及Cobb角无丢失（P＞0.05），两组间比较差异无显著（P>0.05）。
4．骨水泥注入量A、B两组无显著差异（P>0.05），骨水泥注入量与VAS评分无相关关系。
结论：1、经皮椎体成形术治疗椎体转移性肿瘤和骨质疏松性椎体压缩骨折，能有效缓解患者疼痛，提高患者生活质量，是一种安全、有效、微创的手术方法。
2、经皮椎体成形术治疗骨质疏松性椎体压缩骨折疗效优于椎体转移性肿瘤。
Objective To review and analyze the clinical curative effect in metastatic tumorVertebral Compression Fractures and Osteoporsis Vertebral Compression Fractures patientsafter Percutaneous Vertebroplasty.
Methods From January2007to January2011,there were95cases who have anoperation because of Vertebral Compression Fractures in the department of orthopedics ofthe Fourth Affiliated of Soochow University. Adopting questionnaire investigating way tocollect the data of evaluating curative effect by telephone, letter and out-patient callback.According to the reason of Vertebral Compression Fractures, all patients were divided intotwo groups,group A(metastatic tumor),group B (Osteoporosis disease) to analyze theclinical effect according to the assessment scale proposed by Even Lin Liefa and JapaneseOrthorpeadic Assocition(JOA)、Visual analogue scales(VAS)、SF-36and radiographic.Investigatings were learned by statistics. Something was down to compare theimprovement rate of the patients and radiographic with different groups, at same time,analyzing association of the injection of PMMA and the pain grade of VAS.
Results1According to the assessment scale proposed by Even Lin Liefa,there wasstatistical difference between the two groups (P＜0.01).
2In two gruops, there was statistical difference between the pre-operative andpost-operative of the scores of VAS, JOA and SF-36(P<0.05).
3In two gruops, there was no statistical difference between the post-operative ofthe height of anterior and middle portion of the vertebral body (P>0.05). there was nostatistical difference between the pre-operative and post-operative of the scores of theCobb angle.
4There was no statistical difference of the injection of PMMA between thegroup A、 B(P>0.05)，The injection of PMMA were no associated with the pain grade ofVAS.
Conclution:1) Percutaneous Vertebroplasty is a safe, effective and minimal invasivetechnique in treatment and pain relief.
2) The clinical curative effect is satisfied, and there was statistical differencebetween two groups，group B better than group A.
方法：选择随访2007年1月至2011年1月因椎体压缩骨折接受经皮椎体成形术治疗的患者共95例，采用问卷调查方式，通过电话、信函及门诊复查完成疗效评估资料的收集。根据导致椎体压缩骨折的病因，将患者分为A组：椎体转移性肿瘤组和B组：骨质疏松组。采用平林冽法改善率评定标准及VAS、JOA、SF-36评分标准和影像学分别评估，将所调查的数据经统计学处理，分析比较组内/组间疗效、影像学变化特点；并分析骨水泥注入量与VAS评分相关性。
结果：1.两组患者的临床疗效根据平林冽法改善率评定标准，骨质疏松组优良率与椎体转移性肿瘤组比较有显著性差异（P＜0.01）。
2．两组术后VAS、JOA、SF-36评分及疼痛缓解程度，骨质疏松组与肿瘤组比较有显著性差异(P＜0.05)。
3．两组术后椎体前缘、中部高度，术后Cobb角与术前比较，椎体高度及Cobb角无丢失（P＞0.05），两组间比较差异无显著（P>0.05）。
4．骨水泥注入量A、B两组无显著差异（P>0.05），骨水泥注入量与VAS评分无相关关系。
结论：1、经皮椎体成形术治疗椎体转移性肿瘤和骨质疏松性椎体压缩骨折，能有效缓解患者疼痛，提高患者生活质量，是一种安全、有效、微创的手术方法。
2、经皮椎体成形术治疗骨质疏松性椎体压缩骨折疗效优于椎体转移性肿瘤。
Objective To review and analyze the clinical curative effect in metastatic tumorVertebral Compression Fractures and Osteoporsis Vertebral Compression Fractures patientsafter Percutaneous Vertebroplasty.
Methods From January2007to January2011,there were95cases who have anoperation because of Vertebral Compression Fractures in the department of orthopedics ofthe Fourth Affiliated of Soochow University. Adopting questionnaire investigating way tocollect the data of evaluating curative effect by telephone, letter and out-patient callback.According to the reason of Vertebral Compression Fractures, all patients were divided intotwo groups,group A(metastatic tumor),group B (Osteoporosis disease) to analyze theclinical effect according to the assessment scale proposed by Even Lin Liefa and JapaneseOrthorpeadic Assocition(JOA)、Visual analogue scales(VAS)、SF-36and radiographic.Investigatings were learned by statistics. Something was down to compare theimprovement rate of the patients and radiographic with different groups, at same time,analyzing association of the injection of PMMA and the pain grade of VAS.
Results1According to the assessment scale proposed by Even Lin Liefa,there wasstatistical difference between the two groups (P＜0.01).
2In two gruops, there was statistical difference between the pre-operative andpost-operative of the scores of VAS, JOA and SF-36(P<0.05).
3In two gruops, there was no statistical difference between the post-operative ofthe height of anterior and middle portion of the vertebral body (P>0.05). there was nostatistical difference between the pre-operative and post-operative of the scores of theCobb angle.
4There was no statistical difference of the injection of PMMA between thegroup A、 B(P>0.05)，The injection of PMMA were no associated with the pain grade ofVAS.
Conclution:1) Percutaneous Vertebroplasty is a safe, effective and minimal invasivetechnique in treatment and pain relief.
2) The clinical curative effect is satisfied, and there was statistical differencebetween two groups，group B better than group A.
引文
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2. Belkoff SM．Molloy S.Temperature measurement during polymerization of polym-hylmethacrylate cement used for vertebroplasty．Spine，2003，28：1555—1559.
3. Barr JD，Barr MS，Lemley TJ，et a1．Percutaneous vertebroplasty for pain relief andspinal stabilization．Spine，2000，25：923—928．
4. SCHULTE B U，BRUCHER D，Trompeter M，et a1．Balloon—as sisted percutaneousvertebroplasty in patients with osteoporotic vertebral body compression fractures firstresults [J]．Rofo，2006，178(2)：207—213.
5. KAUFMANNN T J，TROUT A T，KALLMES D F．The effects of cement volume onclinical outcomes of percutaneous vertebroplasty [J]．AJNR Am J Neuroradiol，2006，27(9)：1933—1979.
6. CHEUNG G，CHOW E，H0LDEN L，et a1．Percutaneous vertebroplasty inpatients with intractable pain from osteoporotic or metastatic fractures：A prospectivestudy using quality-of-life assessment[J]．Can Assoc Radio [J]，2006.57(1)：13-21.
7. MAR TINEZ-QUINONES J V， ASO-ESCARIO J， AR-REGUI-CALVO YR．Percutaneous vertebral augmentation：vertebroplasty an d kyphoplasty：operativetechnique [J]．Neurocirugia(Astur)[J]，2005,16（5）:427-440.
8. Barr JD，Barr MS，Lemley TJ，et a1．Pereutaneous vertebroplasty forpain relief andspinal stabilization．Spine，2000，25：923-628．
9. Cotten A，Dewatre F，Cortet B，et a1．Pereutaneous vertebroplastyfor osteolytiemetastases and myeloma： efects of the percentage oflesion filling an d the leakage ofmethyl methacrylate at clinical follow up．Radiology，1996，200：525-530．
10.郑召民,刘尚礼.经皮椎体成形术[J].中国脊柱脊髓杂志，2003,2（13）：115-117.
11. Galibert P,Deramond H, treatment desangiomes verlebraux par-vertebroplastieacrylique precutanee[J],Neuro chrurgie,1987：166-167.
12. Chiras J,perculaneous vertebral surgery:Techniques and indications[J].JNeurorad,1995,24:45-52.
13. Kaemmerlen P,Thiess P,et.al.percutaneous vertebroplasty in treatment of metastases:Technic and results[J].JRadiology,1989,90(60):557-62
14. Hentsehel SJ,Burton AW,et al pereutaneous vertebrplasty and Kyphoplasty performedat a cancer refating proposed countraindieations[J],J Neurosurg Spine,2005,2(4):436-440.
15. Kaufmann TJ，Trout AT，Kallmes DF，et a1．The effects of cenlent volume on clinicaloutcomes of percutaneous vertebroplasty[J]．AJNR Am J Neuroradiol，2006，27(9)：1933—1937．
16. Nieuwenhuijse MJ, Bollen L, van Erkel AR, Dijkstra PD. Optimal intravertebralcement volume in percutaneous vertebroplasty for painful osteoporotic vertebralcompression fractures.[J] Spine.2012，37(20):1747-55.
17. Molly S,Mathis JM,Belkoff SM. The effect of vertebralbody percentage fill inmechanical behavior during percutaneous vertebroplasty [J]. Spine,2003,28:1549.
18. Molinari RW， Vertebroplasty and kyphoplasty: biochemics,outcomes, andcomplications [J]. Curr Opin Orthop,2004,15:142.
19. Weukk A,chias J,smon JM,et al Spinal metastses indications for and results ofpercutoneous injection of acrylic [J]surgical cement Radiology,1996:241-247.
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