CAJ | 학술논문

目的探讨经皮椎体成形术(PVP)治疗不同程度OVCF的疗效. 方法回顾性分析2004年1月至2010年10月应用PVP治疗的208例OVCF患者的临床资料,男72例,女136例；年龄70～96岁,平均77.8岁；共242个椎体,其中胸椎134个,腰椎108个.椎体压缩分度的判定及分度方法根据X线片和CT检查选用Genant半定量目测法,椎体压缩骨折Ⅰ、Ⅱ、Ⅲ度的标准分别为椎体压缩比＜25％、25％～ 50％、＞50％.术后测量椎体压缩比,观察脊柱稳定性、疼痛缓解及骨水泥渗漏等相关并发症. 结果 208例患者术后获平均30.5个月(6～84个月)随访,骨水泥注射量平均为胸椎(2.6±0.6)mL,腰椎(4.8±0.4) mL.Ⅰ度压缩比椎体手术前、后压缩比和cobb角比较差异均无统计学意义(P＞0.05).Ⅱ、Ⅲ度压缩比椎体手术前、后压缩比和cobb角比较差异均有统计学意义(P＜0.05).Ⅰ～Ⅲ度压缩比椎体之间疼痛缓解程度差异均无统计学意义(x2=0.955,P＞ 0.05).Ⅰ、Ⅱ、Ⅲ度压缩比椎体骨水泥渗漏率分别为3.2％ (1/31)、10.3％ (15/145)、25.8％ (17/66),但所有患者均未引起临床症状.Ⅰ、Ⅱ、Ⅲ度压缩比椎体的并发症发生率分别为6.5％ (2/31)、6.9％ (10/145)、22.7％(15/66).结论 PVP在治疗OVCF时,压缩程度不同与患者疼痛缓解无必然关系.但随着椎体压缩程度的增加,术后椎体压缩比及cobb角的恢复也较差,建议PVP应早期治疗OVCF,避免椎体进一步压缩.
목적 탐토경피추체성형술(PVP)치료불동정도OVCF적료효. 방법 회고성분석2004년1월지2010년10월응용PVP치료적208례OVCF환자적림상자료,남72례,녀136례；년령70～96세,평균77.8세；공242개추체,기중흉추134개,요추108개.추체압축분도적판정급분도방법근거X선편화CT검사선용Genant반정량목측법,추체압축골절Ⅰ、Ⅱ、Ⅲ도적표준분별위추체압축비＜25％、25％～ 50％、＞50％.술후측량추체압축비,관찰척주은정성、동통완해급골수니삼루등상관병발증. 결과 208례환자술후획평균30.5개월(6～84개월)수방,골수니주사량평균위흉추(2.6±0.6)mL,요추(4.8±0.4) mL.Ⅰ도압축비추체수술전、후압축비화cobb각비교차이균무통계학의의(P＞0.05).Ⅱ、Ⅲ도압축비추체수술전、후압축비화cobb각비교차이균유통계학의의(P＜0.05).Ⅰ～Ⅲ도압축비추체지간동통완해정도차이균무통계학의의(x2=0.955,P＞ 0.05).Ⅰ、Ⅱ、Ⅲ도압축비추체골수니삼루솔분별위3.2％ (1/31)、10.3％ (15/145)、25.8％ (17/66),단소유환자균미인기림상증상.Ⅰ、Ⅱ、Ⅲ도압축비추체적병발증발생솔분별위6.5％ (2/31)、6.9％ (10/145)、22.7％(15/66).결론 PVP재치료OVCF시,압축정도불동여환자동통완해무필연관계.단수착추체압축정도적증가,술후추체압축비급cobb각적회복야교차,건의PVP응조기치료OVCF,피면추체진일보압축.
Objective To investigate therapeutic effects of percutaneous vertebroplasty (PVP) in treatment of varying grades of osteoporotic vertebral compression fracture (OVCF). Methods From January 2004 to October 2010,208 senior OVCF patients were treated by PVP in our department.They were 72 men and 136 women,aged from 70 to 96 years (average,77.8).A total of 242 vertebral bodies were affected,including 134 thoracic and 108 lumbar ones.The fracture and its severity were evaluated according to Genant's semi-quantitative visual method,with OVCF grades Ⅰ, Ⅱ and Ⅲ respectively corresponding to a compression ratio of less than 25％,25％ to 50％ and greater than 50％.The patients were examined postoperation to analyze the ratio of vertebral compression,stability of vertebral body,pain relief and leakage of bone cement. Results All patients in this series were followed up from 6 to 84 months (average,30.5months).The mean cement volumes for thoracic and lumbar bodies were respectively 2.6 ± 0.6 mL and 4.8 ±0.4 mL.The preoperative vertebral compression rate and cobb angle in patients with OVCF grades Ⅱ and Ⅲ were significantly improved postoperation ( P ＜ 0.05) except in the patients with OVCF grade Ⅰ ( P ＞ 0.05).There was no significant difference in pain relief among patients with OVCF grades Ⅰ,Ⅱ and Ⅲ (x2 =0.955,P ＞0.05).The rates of cement leakage were 3.2％ (1/31),10.3％ (15/145) and 25.8％ (17/66) for OVCF grades Ⅰ,Ⅱ and Ⅲ,respectively,but the leakage did not cause clinical symptoms in all patients.The complication rates for OVCFgrades Ⅰ,Ⅱand Ⅲ were respectively 6.5％ (2/31),6.9％ (10/145) and 22.7％ (15/ 66). Conclusions In treatment of varying grades of OVCF,PVP may not make a difference in pain relief,but with increasing OVCF severity it will achieve poorer therapeutic outcomes regarding recovery of vertebral compression and Cobb angle.It is suggested that PVP must be performed for patients with early 0VCF to avoid further vertebral compression.