CAJ | 학술논문

背景:椎体强化治疗已经成为治疗新鲜脊柱压缩骨折公认有效的方法,但对于陈旧压缩骨折是否有效的研究尚少. 目的:比较半年以上陈旧脊柱压缩骨折保守治疗和应用后凸成形术(PKP)进行椎体强化治疗的临床效果. 方法:回顾分析2007年10月至2012年7月,在我院就诊病史半年以上的疼痛性陈旧脊柱压缩骨折患者的病例资料.共61例,男15例,女46例,年龄48~87岁,平均(69.8±9.6)岁.骨折到治疗时间6~24个月,平均(9.3±4.3)个.根据临床症状和经济情况,选择保守或手术治疗.保守组19例,治疗包括支具以及抗骨质疏松药物;手术组42例(60个椎体),在保守治疗基础上行PKP.随访时间9~40个月,平均(13.2±3.6)个月.在治疗前及治疗后2 d、3个月、1年进行评估,包括视觉模拟评分(visual analogue scale, VAS)、EQ-5D健康问卷(European quality of life-5 dimensions scale)和计时站-走测试(timed up and go test, UGT).比较各组治疗前后以及两组之间治疗后的评分和影像学结果. 结果:保守组治疗后3个月VAS、EQ-5D和UGT与术前比较无显著差异;治疗后1年VAS明显优于术前,EQ-5D和UGT无显著差异;Beck指数变化无差异.手术组术后2 d、3个月和1年VAS、EQ-5D、UGT以及Beck指数均优于术前.两组相比,治疗后3个月,手术组的VAS、EQ-5D和UGT及Beck指数均优于保守组;治疗后1年,手术组的EQ-5D和UGT优于保守组,VAS数值低于保守组但无显著差异. 结论:在半年以上的骨质疏松性陈旧脊柱压缩骨折的治疗中,椎体强化在1年内优于保守治疗.更远期的临床效果和各评估工具的应用价值尚需进一步研究.
배경:추체강화치료이경성위치료신선척주압축골절공인유효적방법,단대우진구압축골절시부유효적연구상소. 목적:비교반년이상진구척주압축골절보수치료화응용후철성형술(PKP)진행추체강화치료적림상효과. 방법:회고분석2007년10월지2012년7월,재아원취진병사반년이상적동통성진구척주압축골절환자적병례자료.공61례,남15례,녀46례,년령48~87세,평균(69.8±9.6)세.골절도치료시간6~24개월,평균(9.3±4.3)개.근거림상증상화경제정황,선택보수혹수술치료.보수조19례,치료포괄지구이급항골질소송약물;수술조42례(60개추체),재보수치료기출상행PKP.수방시간9~40개월,평균(13.2±3.6)개월.재치료전급치료후2 d、3개월、1년진행평고,포괄시각모의평분(visual analogue scale, VAS)、EQ-5D건강문권(European quality of life-5 dimensions scale)화계시참-주측시(timed up and go test, UGT).비교각조치료전후이급량조지간치료후적평분화영상학결과. 결과:보수조치료후3개월VAS、EQ-5D화UGT여술전비교무현저차이;치료후1년VAS명현우우술전,EQ-5D화UGT무현저차이;Beck지수변화무차이.수술조술후2 d、3개월화1년VAS、EQ-5D、UGT이급Beck지수균우우술전.량조상비,치료후3개월,수술조적VAS、EQ-5D화UGT급Beck지수균우우보수조;치료후1년,수술조적EQ-5D화UGT우우보수조,VAS수치저우보수조단무현저차이. 결론:재반년이상적골질소송성진구척주압축골절적치료중,추체강화재1년내우우보수치료.경원기적림상효과화각평고공구적응용개치상수진일보연구.
@@@@Background: Vertebral augmentation has been populized as an effictive treatment for fresh vertebral compression fracture;however, for old compression fracture, few study has been reported. @@@@Objective: To evaluate the efficacy of percutaneous kyphoplasty (PKP) versus conservative treatment for patients with pain-ful vertebral compression fractures of more than 6 months' duration. @@@@Methods:From October 2007 to July 2012, 61 patients from our hospital with painful vertebral compression fractures of more than 6 months' duration were enrolled in this study. There were 15 males and 46 females with an average age of (69.8± 9.6) years (range, 48-87 years). The average duration of fracture was (9.3±4.3) months (range, 6-24 months). Concerning of the clinical symptoms and economical condition, 19 patients received only conservative treatment as the conservation group, while 42 patients received conservative treatment and PKP simultaneously as the surgery group. The conservative treatment included bracing and anti-osteoporostic medication. The average follow-up was (13.2±3.6) months (range,9-40 months). Visual analogue scale (VAS), European quality of life-5 dimensions scale (EQ-5D) , timed up and go test (UGT) and Beck index were applied to evaluate clinical outcomes before treatment and 2 days, 3 months and 1 year after treatment, and X-ray evaluation as well. @@@@Results: Compared with those before treatment, in conservation group, no difference was found in VAS, EQ-5D, UGT and Beck index 3 months after treatment, and also in EQ-5D, UGT in 1 year, except VAS showed better in 1 year afterment;while in surgery group, better VAS, EQ-5D, UGT and Beck index were found in 2 days, 3 months and 1 year after surgery. There were significant differnces in VAS, EQ-5D, UGT and Beck index in 3-month follow-up, and EQ-5D and UGT in 1-year follow-up between two groups (P<0.05). No significant difference was found in VAS one year after surgery between two groups. @@@@Conclusions: For patients with painful vertebral compression fractures of more than 6 months' duration, PKP can result in better clinical outcomes than conservative treatment within one year after treatment.