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正骨手法结合经皮椎体成形术与单纯经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折的临床研究

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作者	Author	单位	Address	E-Mail
李稳超	LI Wen-chao	安徽中医药大学, 安徽合肥 230000 南京中医药大学附属苏州市中医医院, 江苏苏州 215009	Anhui University of Chinese Medicine, Hefei 230000, Anhui, China Suzhou Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Suzhou 215009, Jiangsu, China
俞鹏飞	YU Peng-fei	南京中医药大学附属苏州市中医医院, 江苏苏州 215009	Suzhou Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Suzhou 215009, Jiangsu, China
朱广晔	ZHU Guang-ye	南京中医药大学附属苏州市中医医院, 江苏苏州 215009	Suzhou Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Suzhou 215009, Jiangsu, China
郭宏	GUO Hong	南京中医药大学附属苏州市中医医院, 江苏苏州 215009	Suzhou Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Suzhou 215009, Jiangsu, China
李亚浩	LI Ya-hao	南京中医药大学附属苏州市中医医院, 江苏苏州 215009	Suzhou Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Suzhou 215009, Jiangsu, China
张先达	ZHANG Xian-da	安徽中医药大学, 安徽合肥 230000 南京中医药大学附属苏州市中医医院, 江苏苏州 215009	Anhui University of Chinese Medicine, Hefei 230000, Anhui, China Suzhou Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Suzhou 215009, Jiangsu, China
李超	LI Chao	南京中医药大学附属苏州市中医医院, 江苏苏州 215009	Suzhou Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Suzhou 215009, Jiangsu, China
姜宏	JIANG Hong	南京中医药大学附属苏州市中医医院, 江苏苏州 215009	Suzhou Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Suzhou 215009, Jiangsu, China
李红卫	LI Hong-wei	南京中医药大学附属苏州市中医医院, 江苏苏州 215009	Suzhou Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Suzhou 215009, Jiangsu, China	hongwei_li151@126.com

期刊信息：《中国骨伤》2024年，第37卷，第6期，第546-552页

DOI：10.12200/j.issn.1003-0034.20231025

基金项目:江苏省老年健康科研项目(编号:LKM2022055);苏州市卫生健康委员会科技项目(编号:LCZX202113)

中文摘要:

目的: 探讨正骨手法结合经皮椎体成形术(percutaneous vertebroplasty,PVP)与单纯经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松性椎体压缩性骨折(osteoporosis vertebral compression fractures,OVCFs)的临床疗效。

方法: 回顾性分析2021年1月至2022年6月收治的80例单节段OVCFs患者的临床资料,根据手术方式不同分为治疗组和对照组,每组40例。治疗组男24例,女16例;年龄60~83(70.43±7.31)岁;骨密度-3.30~-2.50(-2.84±0.24) SD;T₁₀ 1例,T₁₁ 4例,T₁₂ 11例,L₁ 7例,L₂ 7例,L₃ 5例,L₄ 3例,L₅ 2例;采用正骨手法结合PVP治疗。对照组男27例,女13例;年龄60~82(68.98±6.94)岁;骨密度-3.40~-2.50(-2.76±0.23) SD;T₁₀ 2例,T₁₁ 3例,T₁₂ 13例,L₁ 11例,L₂5例,L₃ 3例,L₄ 2例,L₅ 1例;单纯PKP手术治疗。比较两组术前、术后3 d及术后3、12个月的疼痛视觉模拟评分(visual analogue scale,VAS)、腰椎Oswestry功能障碍指数(Oswestry disability index,ODI);并比较两组术前、术后3 d及术后12个月伤椎局部后凸角、椎体楔形角和椎体前缘高度比的变化情况。

结果: 两组患者均顺利完成手术。两组均获得随访,治疗组随访时间13~22(16.82±2.14)个月,对照组随访时间13~23(16.45±2.56)个月。治疗组3例术中出现骨水泥渗漏;对照组1例术中出现骨水泥渗漏、1例术后出现下肢皮肤感觉障碍;两组并发症比较,差异无统计学意义(P>0.05)。两组术前VAS、ODI比较,差异无统计学意义(P>0.05);治疗后3 d,治疗组VAS (3.68±0.62)分与对照组(4.00±0.72)分比较,差异有统计学意义(P<0.05);两组术后3、12个月VAS、ODI比较,差异无统计学意义(P>0.05)。两组术后3 d及术后12个月局部后凸角、椎体楔形角、椎体前缘高度比较,差异无统计学意义(P>0.05)。

结论: 正骨手法结合PVP治疗OVCFs相对于单纯PKP在术后早期疼痛缓解方面更具有优势;在椎体高度恢复方面,正骨手法结合PVP与单纯PKP疗效相近。

【关键词】正骨手法经皮椎体成形术经皮椎体后凸成形术骨质疏松性椎体压缩骨折

Comparsion of bone setting technique combined with percutaneous vertebroplasty and percutaneous kyphoplasty for the treatment of osteoporotic vertebral compression fractures

ABSTRACT

Objective To explore clinical efficacy of osteoplasty combined with percutaneous vertebroplasty(PVP) and percutaneous kyphoplasty (PKP) alone in treating osteoporosis vertebral compression fractures (OVCFs).

Methods The clinical data of 80 patients with single-level OVCFs treated from January 2021 to June 2022 were retrospectively analyzed,and were divided into treatment group and control group according to different surgical methods,40 patients in each group. In treatment group,there were 24 males and 16 females,aged from 60 to 83 years old with an average of (70.43±7.31) years old;bone mineral density ranged from -3.30 to -2.50 SD with an average of(-2.84±0.24) SD;1 patient with T₁₀,4 patients with T₁₁,11 patients with T₁₂,7 patients with L₁,7 patients with L₂,5 patients with L₃,3 patients with L₄,2 patients with L₅;bone setting technique combined with PVP were performed. In control group,there were 27 males and 13 females,aged from 60 to 82 years old with an average of (68.98±6.94) years old;bone mineral density ranged from -3.40 to -2.50 SD with an average of (-2.76±0.23) SD;2 patients with T₁₀,3 patients with T₁₁,13 patients with T₁₂,11 patients with L₁,5 patients with L₂,3 patients with L₃,2 patients with L₄,1 patient with L₅;simple PKP were peformed. Visual analogue scale (VAS) and lumbar Oswestry disability index (ODI) were compared between two groups before operation,3 days,3 and 12 months after operation. The changes of local kyphotic angle,vertebral wedge angle and vertebral anterior margin height ratio were compared between two groups before operation,3 days and 12 months after operation.

Results All patients were successfully completed operation. Treatment group were followed up from 13 to 22 months with an average of (16.82±2.14) months,and control group were followed up from 13 to 23 months with an average of (16.45±2.56) months. Three patients were occurred bone cement leakage in treatment group,while 1 patient were occurred bone cement leakage and 1 patient occurred sensory disturbance of lower limb skin in control group;there were no significant difference in complications between two groups (P>0.05). There were no significant difference in preoperative VAS and ODI between two groups (P>0.05). At 3 days after operation,VAS of treatment group 3.68±0.62 was significantly higher than that of control group 4.00±0.72 (P<0.05). There were no significant difference in VAS and ODI between two groups at 3 and 12 months after operation (P>0.05). There were no significant difference in local kyphotic angle,vertebral wedge angle and vertebral anterior margin height between two groups at 3 days and 12 months after operation (P>0.05).

Conclusion Compared with PKP,bone setting manipulation combined with PVP for the treatment of OVCFs has advantages in early postoperative pain relief. In terms of vertebral height recovery,bone setting manipulation combined with PVP and PKP alone have similar clinical effects.

KEY WORDS Bone setting technique Percutaneous vertebro plasty Percutaneous kyphoplasty Osteoporosis vertebral compression fractures

引用本文，请按以下格式著录参考文献：

中文格式:	李稳超,俞鹏飞,朱广晔,郭宏,李亚浩,张先达,李超,姜宏,李红卫.正骨手法结合经皮椎体成形术与单纯经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折的临床研究[J].中国骨伤,2024,37(6):546~552
英文格式:	LI Wen-chao,YU Peng-fei,ZHU Guang-ye,GUO Hong,LI Ya-hao,ZHANG Xian-da,LI Chao,JIANG Hong,LI Hong-wei.Comparsion of bone setting technique combined with percutaneous vertebroplasty and percutaneous kyphoplasty for the treatment of osteoporotic vertebral compression fractures[J].zhongguo gu shang / China J Orthop Trauma ,2024,37(6):546~552

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