摘要
目的比较急性症状性骨质疏松性胸腰椎骨折(AS0TLF)分型Ⅰ型骨折经皮椎体成形术(PVP)与非手术治疗的临床疗效。方法采用回顾性病例对照研究分析2015年1月至2018年12月西安交通大学附属红会医院收治的115例ASOTLF患者临床资料,其中男48例,女67例;年龄65〜92岁[(75.3±8.5)岁]。根据临床症状和影像学特征,均为ASOTLF分型Ⅰ型患者。损伤节段:T_(6)~T_(10)10例,T_(11)15例,T_(12)26例,L_(1)34例,L_(2)8例,L_(3)7例,L_(4)5例。73例采用PVP联合抗骨质疏松治疗(手术组),42例采用非手术联合抗骨质疏松治疗(非手术组)。治疗前、治疗后1 d、1个月、3个月、6个月及末次随访时,采用视觉模拟评分(VAS)评估疼痛程度,采用罗兰•莫里斯残疾问卷(RMD)评分评估脊柱功能,采用欧洲骨质疏松症基金会生活质量问卷(QUALEFF0)评分评估生活质量。比较治疗1年后两组患者的骨密度。观察并发症发生情况。结果患者均获随访12-18个月[(13.2±4.6)个月治疗后1d、1个月、3个月,手术组VAS分别为(3.9±0.6)分、(3.3±0.6)分、(2.9±0.3)分,显著低于非手术组的(6.0±0.7)分、(5.0±0.8)分、(4.2±1.0)分(P均<0.05);手术组RMD评分分别为(15.2±0.7)分、(12.6±0.7)分、(10.6±0.7)分,显著低于非手术组的(16.4±0.8)分、(14.6±0.8)分、(12.7±0.6)分(P均<0.05).治疗后1 d、1个月,手术组QUALEFFO评分分别为(46.0±1.1)分、(41.4±0.8)分,低于非手术组的(50.3±0.8)分、(44.7±1.2)分(P均<0.05).以上指标其余时相点两组间差异均无统计学意义(P>0.05).治疗后1年手术组骨密度T值为(-3.0±0.9)80,非手术组为(-2.8±1.1)SD(P>0.05)。手术组并发症发生率为37%(27/73),非手术组为33%(14/42)(P>0.05)。结论对于ASOTLF分型I型骨折,PVP与非手术在抗骨质疏松和并发症发生方面疗效相当,但PVP在早期缓解疼痛、改善脊柱功能、提高生活质量等方面优于非手术治疗。
Objective To compare the clinical efficacy of percutaneous vertebroplasty(PVP)and non-surgical treatment of patients with type I fracture according to the acute symptomatic osteoporotic thoracolumbar fracture(ASOTLF)classification.Methods A retrospective case-control study was used to analyze the clinical data of 115 patients with ASOTLF admitted to Honghui Hospital of Xi'an Jiaotong University from January 2015 to December 2018.There were 48 males and 67 females,aged 65-92 years[(75.3±8.5)years].According to clinical symptoms and imaging characteristics,all patients were identified with type I fracture according to the ASOTL.F classification.Injury segments were at T_(6) to T_(10) in 10 patients,at T_(11)in 15,at T_(12) in 26,at L_(1)in 34,ay L_(2) in 18,at L_(3) in 7,and at L_(4) in 5.A total of 73 patients received PVP combined with anti-osteoporosis treatment(surgery group),and 42 patients received non-surgery combined anti-osteoporosis treatment(non-surgery group).Before treatment,at 1 day,1 month,3 months,6 months after treatment,and at the last follow-up,the visual analogue scale(VAS)was used to assess the pain,the Roland Moms Disability(RMD)score to assess the spinal function,and the Quality of Life Questionnaire of the European Foundation for Osteoporosis(QUALEFFO)score to evaluate the quality of life.The hone mineral density was compared between groups before treatment and at 1 year after treatment.The complications were observed as well.Results All patients were followed up for 12-18 months[(13.2±4.6)months].At 1 day,1 month,and 3 months after treatment,the VAS in surgery group[(3.9±0•6)points,(3.3±0.6)points,(2.9±0.3)points]was significantly lower than that in non-surgery group[(6.0±0.7)points,(5.0±0.8)points,(4.2±1.0)points,respectively](all<0.05);the RM1)score in surgery group[(15.2±0.7)points,(12.6±0.7)points,(10.6±0.7)points]was significantly lower than that in non-surgery group[(16.4±0.8)points,(14.6±0.8)points,(12.7±0.6)points,respectively](all PcO.OS).At 1(lay and 1 month after treatment,the QUALEFFO score in surgery group[(46.0±1.1)points,(41.4±0.8)points]was lower than that in non-surgery group[(50.3±0.8)points,(44.7±1.2)points](all P<0.05).There was no statistically significant difference between the two groups at other time points of the above indicators(P>0.05).At 1 year after treatment,the hone mineral density in surgery group was(-3.0±0.9)SD,and was(-2.8±1.1)SD in non-surgery group(P>0.05).There was no significant difference in the incidence of complications between surgery group[37%(27/73)]and non-surgery group[33%(14/42)](P>0.05).Conclusion For patients with ASOTLF type Ⅰ fracture,PVP and non-surgical treatment has similar effects in anti-osteoporosis and occunence of complications,but the PVP is superior to non-surgical treatment in early pain relief,spinal function improvement and quality of life.
作者
李庆达
杨俊松
高林
贺宝荣
刘团江
章雪芳
张嘉男
田欣
何昌军
杨明义
拓源
郝定均
Li Qingda;Yang Junsong;Gao Lin;He Baorong;Liu Tuanjiang;Zhang Xuefang;Zhang Jianan;Tian Xin;He Changjun;Yang Mingyi;Tuo Yuan;Hao Dingjun(Yan’an University Medical School,Yan’an 716000,China;Department of Spine Surgery,Honghui Hospital,Xi’an Jiaotong University Faculty of Medicine,Xi’an 710054,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2021年第6期541-548,共8页
Chinese Journal of Trauma
基金
国家自然科学基金(81830077,81772357)。
