褚定坤 陶晓冰 郜顺兴 杨中华 王军 田伟荣

[摘要] 目的 探討改良椎体成形术（PVP）治疗骨质疏松性多发椎体压缩性骨折的临床效果及安全性。 方法 采用前瞻性随机对照单盲研究，收集2013年10月～2014年10月在河北省沧州中西医结合医院住院治疗的骨质疏松性多发椎体压缩性骨折患者60例，随机分为两组，治疗组30例（85节椎体）采用改良PVP方法，对照组30例（81节椎体）采用传统PVP方法。观察两组患者手术时间、骨水泥注入量、手术前后疼痛视觉模拟评分（VAS）及Oswestry功能障碍指数（ODI）评分等。 结果 两组患者PVP技术操作成功率均为100%。治疗组手术时间为（18.23±3.49）min，对照组为（43.58±5.72）min，差异有高度统计学意义（P < 0.01）。治疗组骨水泥注入量为（2.36±0.92）mL，对照组为（3.83±0.46）mL，差异有高度统计学意义（P < 0.01）。两组患者手术前后VAS比较差异均有高度统计学意义（P < 0.01）；两组患者术前、术后3 d的VAS比较，差异均无统计学意义（P > 0.05）。两组患者手术前后ODI评分比较差异有高度统计学意义（P < 0.01）；两组患者术前、术后3 d的ODI评分比较，差异无统计学意义（P > 0.05）。 结论 改良PVP治疗方案不仅可以改善患者生活质量，减轻患者疼痛，而且简化了手术操作步骤，节约治疗费用，风险较传统手术方式降低，是治疗骨质疏松性多发椎体压缩性骨折安全、有效、可行、值得推广的方法。

[关键词] 改良椎体成形术；骨质疏松性多发椎体压缩性骨折；骨水泥；技术改良

[中图分类号] R683 [文献标识码] A [文章编号] 1673-7210（2016）02（c）-0091-04

Clinical effect of modified percutaneous vertebroplasty in the treatment of multiple osteoporotic vertebral compressed fracture

CHU Dingkun TAO Xiaobing GAO Shunxing YANG Zhonghua WANG Jun TIAN Weirong

Department of Spine and Spinal Cord， Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine， Hebei Province， Cangzhou 061001， China

[Abstract] Objective To investigate clinical effect and safety of modified percutaneous vertebroplasty （PVP） in the treatment of multiple osteoporotic vertebral compressed fracture. Methods Prospective randomized controlled single blind study was applied. 60 patients with multiple osteoporotic vertebral compressed fracture treated in Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine of Hebei Province from October 2013 to October 2014 were selected and randomly assigned to two groups. Modified PVP method was used in treatment group （30 cases， 85 vertebrae）， traditional PVP method was applied in control group （30 cases， 81 vertebrae）. Operation time， bone cement using volume， visual analogue scale （VAS）， ODI score before and after operation between two groups were observed. Results The success rate of PVP method in two groups was 100%. In treatment group， operation time was （18.23±3.49） min， control group was （43.58±5.72） min， the difference was statistically significant （P < 0.01）. In treatment group， bone cement using volume was （2.36±0.92） mL， control group was （3.83±0.46） mL， the difference was statistically significant （P < 0.01）. VAS of two groups before and after operation were compared， with statistically significant differences （P < 0.01）. Preoperative and postoperative 3 d， VAS of two groups were compared， with no statistical difference （P > 0.05）. ODI score of two groups before and after operation were compared， with statistically significant differences （P < 0.01）. Preoperative and postoperative 3 d， ODI score of two groups were compared， with no statistical difference （P > 0.05）. Conclusion Modified PVP method can not only improve quality of life， reduce the pain， but also simplify operation procedure， save the cost， and reduce the operation risk. It is a safe， effective and feasible method in the treatment of multiple osteoporotic vertebral compressed fracture.

[Key words] Modified percutaneous vertebroplasty； Multiple osteoporotic vertebral compressed fracture； Bone cement； Technical improvement

随着人口老龄化社会的到来，骨质疏松症已经发展成为老年人健康的主要威胁之一[1]，骨折为该病的主要严重并发症，骨质疏松性椎体压缩性骨折（osteoporotic vertebral compression fracture，OVCF）已经成为世界范围内主要的健康问题之一，不仅由于此类骨折的发病率高，而且由于其直接或间接地影响患者的生活质量，甚至危及生命[2]。

对于OVCF，传统的治疗手段如：卧床、非甾体抗炎药（NSAID）等保守治疗，但保守过程痛苦，且并发压疮、坠积性肺炎等风险增加，少数患者经保守治疗临床症状无缓解，需要进一步手术治疗，但老年患者，行外科切开手术因创伤大而限制其临床难以广泛应用。……