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目的探讨经皮椎体成形术(percutaneous vertebroplasty,PVP)和椎体后凸成形术(percutaneous kyphoplasty,PKP)两种微创椎体成型术治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCFs)的疗效差异。方法 2014年1月—2015年8月回顾性分析64例OVCFs患者的临床资料,根据治疗方法的不同分为两组,PVP组33例,采用PVP治疗,PKP组31例,采用PKP治疗,观察手术一般情况、手术时间、住院时间和费用,对比观察两组术前、术后1 d和术后7 d疼痛视觉模拟评分(visual analogue pain scale,VAS)以及手术前后伤椎前缘高度、伤椎后凸角度(Cobb角)以及后凸畸形矫正率,对比观察两组术后骨水泥渗漏发生率。计数资料采用χ2检验或者Fisher’s精确概率法,计量资料比较均采用t检验,P<0.05为差异有统计学意义。结果 PVP组手术时间、治疗费用[(44.12±7.21)min、(2.21±0.39)万元]与PKP组[(58.84±6.67)min、(3.92±0.47)万元]对比差异均有统计学意义(均P<0.05)。PVP组与PKP组住院时间对比差异无统计学意义(P>0.05)。PVP组术前、术后1 d和术后7 d VAS评分分别为(9.12±0.54)、(5.02±1.13)、(3.11±0.87)分,PKP组术前、术后1 d和术后7 d VAS评分分别为(9.08±0.57)、(5.10±1.16)、(3.04±0.69)分,两组间VAS评分比较差异均无统计学意义(均P>0.05)。PVP组术前伤椎前缘高度为(14.51±3.43)mm,伤椎Cobb角为(12.69±3.66)℃,术后伤椎前缘高度为(19.90±4.47)mm,伤椎Cobb角为(7.09±2.87)℃,后凸畸形矫正率为(44.13±5.79)%,PKP组术前伤椎前缘高度为(14.64±3.65)mm,伤椎Cobb角为(13.03±3.72)℃,术后伤椎前缘高度为(19.32±4.55)mm,伤椎Cobb角为(7.15±2.59)℃,后凸畸形矫正率为(44.12±6.09)%,两组术后伤椎前缘高度比较和伤椎Cobb角比较差异均有统计学意义(均P<0.05),两组术后伤椎前缘高度、伤椎Cobb角组间比较差异均无统计学意义(均P>0.05),两组术后后凸畸形矫正率比较差异无统计学意义(P>0.05)。PVP组10例(30.30%)骨水泥渗漏,PKP组1例(3.23%)骨水泥渗漏,两组骨水泥渗漏率比较差异有统计学意义(P<0.05)。结论 PVP和PKP两种微创椎体成型术治疗OVCFs在缓解疼痛、恢复椎体高度、纠正后凸畸形方面无明显差异,PVP手术时间短、治疗费用低,而PKP骨水泥渗漏发生率低,两者各有优劣。
Objective To investigate the effect of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) on osteoporotic vertebral compression fracture OVCFs). Methods The clinical data of 64 patients with OVCFs were retrospectively analyzed from January 2014 to August 2015. According to the different treatment methods, the patients were divided into two groups. PVP group (33 cases), PVP group (31 cases) and PKP group The general operation, operation time, hospitalization time and expense were compared between the two groups before and after operation, visual analogue pain scale (VAS) at 1 d and 7 d after operation, Vertebral angle (Cobb angle) and kyphosis correction rate, the incidence of postoperative bone cement leakage was compared between the two groups. Counting data using χ2 test or Fisher’s exact test, measurement data were compared using t test, P <0.05 for the difference was statistically significant. Results There was significant difference in the operation time, the cost of treatment [(44.12 ± 7.21) min, (2.21 ± 0.39) million vs PVP [(58.84 ± 6.67) min, (3.92 ± 0.47) million] (All P <0.05). There was no significant difference in hospitalization time between PVP group and PKP group (P> 0.05). The VAS scores of PVP group before operation, 1 d after operation and 7 d after operation were (9.12 ± 0.54), (5.02 ± 1.13), (3.11 ± 0.87), PKP preoperative, postoperative 1 d and postoperative 7 d VAS scores were (9.08 ± 0.57), (5.10 ± 1.16), (3.04 ± 0.69) points respectively. There was no significant difference in VAS scores between the two groups (all P> 0.05). The height of the anterior vertebral fracture in PVP group was (14.51 ± 3.43) mm, the average Cobb angle was (12.69 ± 3.66) ℃ in the PVP group, and (19.90 ± 4.47) mm in the PVP group. The Cobb angle was 7.09 ± 2.87) ℃. The kyphosis correction rate was (44.13 ± 5.79)% in PKP group, and (14.64 ± 3.65) mm in preoperative PKP group and (13.03 ± 3.72) ℃ in PKP group, The height of anterior margin of injured vertebra was (19.32 ± 4.55) mm, the Cobb angle of injured vertebra was (7.15 ± 2.59) ℃, and the correction rate of kyphosis was (44.12 ± 6.09)%. (All P <0.05). There was no significant difference in the anterior vertebral height and Cobb angle between the two groups (all P> 0.05) There was no significant difference in the correction rate of posterior kyphosis (P> 0.05). There were 10 cases (30.30%) of cement leakage in PVP group and 1 case (3.23%) of cement leakage in PKP group. There was significant difference in the leakage rate of bone cement between the two groups (P <0.05). Conclusion Both PVP and PKP minimally invasive vertebroplasty treatment of OVCFs in the ease of pain, vertebral height restoration, correction of kyphosis no significant difference in PVP surgery time is short, the cost of treatment is low, and the incidence of PKP cement leakage is low Both have their own advantages and disadvantages.