郑灿+胡德志+李笔锋

[摘要] 目的 探讨术前垫枕结合经皮椎体成形术（PVP）治疗骨质疏松性胸腰椎压缩性骨折（OVCF）的临床效果。 方法 收集2014年1月～2015年3月清远市中医院骨科住院及满足纳入标准、排除标准、脱落标准的90例OVCF患者，采用随机数字表法分为两组，每组各45例。A组患者行PVP治疗，B组患者行术前垫枕+PVP治疗。经过6个月治疗及随访，通过手术前后疼痛评估、影像学评估、Cobb角测量及总体疗效评价临床治疗效果。 结果 术后各时间点两组患者VAS评分均显著低于入院时，差异有统计学意义（P < 0.05），术后3 d两组VAS评分差异无统计学意义（P > 0.05），但术后3及6个月时B组VAS评分明显低于A组（P < 0.05）。术后各时间点两组患者伤椎前缘及伤椎中部高度压缩率均明显低于入院时，且B组显著低于A组，差异有统计学意义（P < 0.05）。术后各时间点两组患者Cobb角明显小于入院时，且B组Cobb角较明显小于A组，差异有统计学意义（P < 0.05）。A组患者治疗有效率为80.0%，B组患者治疗有效率为95.6%，B组有效率高于A组，差异有统计学意义（P < 0.05）。 结论 PVP能快速缓解OVCF的疼痛症状，术前垫枕结合PVP效果更佳，尤其在长期恢复椎体高度、缓解疼痛方面具有优势，值得临床推广。

[关键词] 骨质疏松；骨质疏松性胸腰椎压缩性骨折；经皮椎体成形术；垫枕疗法

[中图分类号] R683 [文献标识码] A [文章编号] 1673-7210（2016）10（c）-0091-04

[Abstract] Objective To investigate the clinical effect of preoperative bolster combined with percutaneous vertebroplasty （PVP） in the treatment of osteoporotic vertebral compression fracture （OVCF）. Methods 90 patients with OVCF met the inclusion criteria， exclusion criteria and shedding standards treated in Department of Orthopaedics， Qingyuan Hospital of Traditional Chinese Medicine from January 2014 to March 2015 were selected， and divided into two groups by random number table method， each group had 45 cases. Patients in group A were given PVP treatment， and patients in group B were given preoperative bolster combined with PVP. All patients were followed up for 6 months. Pain assessment， radiographic evaluation， Cobb angle measurement and overall curative effect were used for therapeutic effect evaluation before and after surgery. Results After operation， the VAS scores of the two groups at each time point were significantly lower than those at the time of admission， and the differences were statistically significant （P < 0.05）. 3 days after surgery， the difference of VAS score between the two groups was not significant （P > 0.05）， but at postoperative 3 and 6 months， VAS scores in group B were significantly lower than those in group A （P < 0.05）. After operation， the compression ratios of both front and middle of injured vertebral body were significantly lower than those at the time of admission， and the compression ratios of group B were significantly lower than group A， the differences were statistically significant （P < 0.05）. After operation， the Cobb angles of the two groups at each time point were significantly smaller than those at the time of admission， and the Cobb angles of group B were significantly smaller than group A， the differences were statistically significant （P < 0.05）. The total effective rate of patients in group A was 80.0%，which was 95.6% in group B， the overall efficacy of group B was significantly higher than that of group A， and the difference was statistically significant （P < 0.05）. Conclusion The pain symptoms of OVCF can be quickly relieved by PVP treatment and if combined with preoperative bolster， the effect is better， especially in the long-term recovery of vertebral height and the pain relief. It is worthy of clinical application.

[Key words] Osteoporosis； Osteoporotic vertebral compression fracture； Percutaneous vertebroplasty； Preoperative bolster

随着年龄的增长，骨组织发生的钙丢失、骨密度下降、骨结构紊乱等退行性病变称为骨质疏松[1]。当骨质疏松出现临床症状时称为骨质疏松症[2]。骨折是骨质疏松症的常见临床表现之一，其中，胸腰椎椎体因骨质疏松引起的骨折称为骨质疏松性胸腰椎压缩性骨折（osteoporotic vertebral compression fracture，OVCF）[3]。目前，治疗OVCF的主要临床措施包括保守治疗与微创手术，经皮椎体成形术（percutaneous vertebropiasty，PVP）作为微创手术的代表方法已经广泛应用于临床。同时，从祖国传统医学发展而来的垫枕疗法在保守治疗OVCF方面具有良好的临床效果，在垫枕的基础上行PVP，更有利于术中骨水泥的弥散，进而提高临床疗效。2014年1月～2015年3月清远市中医院骨科运用术前垫枕+PVP的治疗方法对住院的45例OVCF患者进行治疗，取得了较好效果，现总结报道如下：