椎体成形术治疗痛性陈旧性骨质疏松椎体压缩性骨折的疗效分析

Effect analysis of vertebroplasty in the treatment of painful old osteoporotic vertebral compression fractures

摘要:

目的 评估痛性陈旧性骨质疏松椎体压缩性骨折行椎体成形术后的临床效果及安全性。方法 筛选入组陈旧性骨质疏松椎体压缩性骨折的患者共78例,随机分为保守治疗组和手术治疗组,分别行神经阻滞治疗和椎体成形术。通过VAS评分及QOL评分,评估两组患者入院时,治疗后1w、1m和6m的疼痛缓解程度及生活质量改善情况。通过随访,统计术后相邻椎体压缩骨折的发生率。结果 治疗前后比较,两组治疗后1w、1m、6m的VAS评分均明显降低,QOL评分均明显升高,差异有统计学意义(P＜0.05)。两组间比较,治疗后1w、1m和6m时,手术组VAS评分为2.24±1.23,2.42±1.35和2.77±1.73,保守组VAS评分为4.61±1.45,4.97±1.56和5.48±1.90,手术组VAS评分更低,差异有统计学意义(P<0.05)；手术组QOL评分为50.78±6.23,48.08±7.69和47.37±6.28,保守组QOL评分为40.33±7.43,33.11±6.09和30.17±9.01,手术组QOL评分更高,差异有统计学意义(P＜0.05)。随访6个月,保守治疗组相邻椎体压缩骨折的发生率为18.2％(6／33例),手术治疗组相邻椎体压缩骨折的发生率为17.8％(8／45例),差异无统计学意义(P＞0.05)。结论 痛性陈旧性骨质疏松椎体压缩性骨折行椎体成形术可以明显缓解患者的疼痛,显著改善生活质量,且不增加相邻椎体压缩骨折风险。

Abstract:

Objective To evaluate the clinical efficacy and safety of vertebroplasty for painful old osteoporotic vertebral compression fractures. Methods A total of 78 patients with old osteoporotic vertebral compression fracture were selected and randomly divided into conservative treatment group and surgical treatment group, which received nerve block treatment and vertebroplasty, respectively. VAS score and QOL score were used to evaluate the degree of pain relief and the improvement of quality of life in the two groups at admission and 1w, 1m and 6m after treatment. The incidence of compression fracture of adjacent vertebral body after operation was analyzed by follow-up. Results The VAS scores of conservative group and operation group were significantly decreased and QOL scores were significantly increased 1w, 1m, 6m after treatment, and the differences were statistically significant (P < 0.05). Compared between the two groups, at 1w, 1m and 6m after treatment, the VAS scores of the surgery group were 2.24±1.23, 2.42±1.35 and 2.77±1.73, and those of the conserve ative group were 4.61±1.45, 4.97±1.56 and 5.48±1.90, and the VAS scores of the surgery group were lower. The difference was statistically significant (P<0.05); The QOL scores of the surgery group were 50.78±6.23, 48.08±7.69 and 47.37±6.28, and those of the conservative group were 40.33±7.43, 33.11±6.09 and 30.17±9.01. The QOL scores of the surgery group were higher, and the difference was statistically significant (P<0.05). After 6 months of follow-up, the incidence of adjacent vertebral compression fracture was 18.2% (6/33 cases) in the conservative treatment group and 17.8% (8/45 cases) in the surgical treatment group, and the difference was not statistically significant (P>0.05). Conclusion Vertebroplasty for painful old osteoporotic vertebral compression fractures can significantly relieve pain and improve quality of life, without increasing the risk of adjacent vertebral compression fractures.