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目的探讨经皮椎体成形术(percutaneous vertebroplasty,PVP)结合应用胸腰骶固定矫形器支具固定90 d治疗胸腰椎(T10~L4)骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCF)的临床疗效,并设经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗OVCF为对照组比较疗效。方法整群选取2012年1月—2015年12月南京军区福州总医院第一附属医院采用PVP治疗的112例胸腰椎骨质疏松性OVCF患者的资料,其中PVP组(以下统称为A组)56例,PVP结合应用胸腰骶固定矫形器支具组(以下统称为B组)56例,男39例,女89例;年龄61~93岁,平均(78.6±11)岁。骨折节段:T10 12例,T11 24例,T12 25例,L1 26例,L2 25例,L3 16例。受累节段椎体前缘平均压缩为66%(56%~78%)。全部采用双侧椎弓根基底部穿刺入路手术。记录手术时间、骨水泥注射量,术后及随访时复查DR了解骨水泥分布;比较术前1 d、术后3 d及末次随访视觉模拟评分(visual analog scale,VAS评分)、Oswestry功能障碍指数(ODI)、受累节段椎体前缘高度(anterior height,AH)及Cobb角、手术椎体再骨折及塌陷发生率、相邻节段椎体骨折发生率。结果两组所有患者顺利完成手术。随访3~12个月,术后3 d及末次随访VAS评分、Oswestry功能障碍指数(ODI)、受累节段椎体前缘高度值(anterior height,AH)及Cobb角均较术前明显改善差异无统计学意义(P>0.05)。A组及B组手术椎体再骨折再塌陷发生率分别为10.71%、0.00%,相邻节段椎体骨折发生率分别为12.50%、0.00%,差异有统计学意义(P<0.05)。结论 A组及B组治疗胸腰椎骨质疏松性OVCF均可以有效缓解胸背痛、活动能力及功能障碍指数(ODI),部分恢复受累节段椎体前缘高度及后凸角,但PVP结合应用胸腰骶固定矫形器支具有效预防手术椎体再骨折再塌陷及相邻节段椎体骨折,而A组则不能,故PVP结合应用胸腰骶固定矫形器支具治疗OVCF疗效与PVP相仿,但其在预防手术椎体再塌陷及相邻节段椎体骨折等并发症上有优势,适合治疗OVCF。
Objective To investigate the effect of percutaneous vertebraloplasty (PVP) combined with thoracolumbar sacral fixation orthosis brace for 90 days in the treatment of osteoporotic vertebral compression fractures (OVCF, T10 ~ L4) ), And set percutaneous vertebroplasty (PVP) treatment of OVCF as the control group to compare the curative effect. Methods A total of 112 patients with osteoporotic thoracolumbar osteoporosis OVCF from January 2012 to December 2015 in the First Affiliated Hospital of Fuzhou General Hospital of Nanjing Military Region were enrolled in this study. Among them, PVP group (hereinafter referred to as group A) 56 Cases, PVP combined with thoracolumbar sacral fixation orthosis brace group (hereinafter referred to as group B) 56 cases, 39 males and 89 females; aged 61 to 93 years, mean (78.6 ± 11) years. Fracture segments: T10 12 cases, T11 24 cases, T12 25 cases, L1 26 cases, L2 25 cases, L3 16 cases. The average compression of the anterior segment of the affected segment was 66% (56% -78%). All bilateral pedicle base puncture surgery. The time of operation, the amount of bone cement injected, the postoperative follow-up and follow-up examination of DR were used to understand the distribution of bone cement. The visual analog scale (VAS score), the index of Oswestry disability index (ODI), the anterior height (AH) and Cobb angle of the affected segment, the rate of vertebral fracture and collapse, the incidence of vertebral fractures in adjacent segments. Results All patients in both groups successfully completed the operation. The VAS score, Oswestry Disability Index (ODI), anterior height (AH) and Cobb angle of the affected segment at 3 and 12 months after operation were significantly improved at 3 and 3 months postoperatively No statistical significance (P> 0.05). In group A and group B, the incidences of reconstructive fractures of vertebral body fractures were 10.71% and 0.00% respectively. The incidences of vertebral fractures in adjacent segments were 12.50% and 0.00%, respectively. The difference was statistically significant (P <0.05). CONCLUSION: The treatment of osteoporotic OVCF in group A and B can effectively relieve chest pain, mobility and dysfunction index (ODI), partially restore the anterior vertebral height and kyphosis angle of the affected segment, but PVP binding The application of thoracolumbar sacral fixation orthosis brace effectively prevent vertebral body fractures and then collapse and adjacent vertebral fractures, while the group A can not, so the combination of PVP and thoracolumbar sacral fixation orthosis brace efficacy of OVCF and PVP But its advantages in preventing the collapse of the vertebral body and adjacent vertebral fractures and other complications, suitable for the treatment of OVCF.