改良PVP治疗老年中段胸椎OVCF合并退变性脊柱疾病患者的效果

doi:10.3760/cma.j.cn441417-20240710-09002

国际医药卫生导报 ›› 2025, Vol. 31 ›› Issue (9): 1415-1420.DOI: 10.3760/cma.j.cn441417-20240710-09002

改良PVP治疗老年中段胸椎OVCF合并退变性脊柱疾病患者的效果

张博¹ 张斌²

¹陕西省核工业二一五医院脊柱外科，咸阳 712000；²宁强县中医医院骨伤科，汉中 724400

收稿日期:2024-07-10 出版日期:2025-05-01 发布日期:2025-05-20
通讯作者: 张斌，Email：zhangbdoctor@163.com
基金资助:
陕西省重点研发计划（2020SF-187）

Efficacy of modified PVP in the treatment of senile patients with mid-thoracic OVCF complicated with degenerative spinal disease

Zhang Bo¹, Zhang Bin²

¹Department of Spine Surgery, Shaanxi Nuclear Industry 215 Hospital, Xianyang 712000, China; ²Department of Orthopedics and Traumatology, Ningqiang Hospital of Traditional Chinese Medicine, Hanzhong 724400, China

Received:2024-07-10 Online:2025-05-01 Published:2025-05-20
Contact: Zhang Bin, Email: zhangbdoctor@163.com
Supported by:
Shaanxi Province Key Research and Development Plan (2020SF-187)

摘要/Abstract

摘要：

　目的　探讨CT引导下改良单侧椎弓根入路椎体成形术（PVP）治疗老年中段胸椎（T5～T9）骨质疏松性椎体压缩骨折（OVCF）合并退变性脊柱疾病患者的效果。方法　回顾性分析2019年2月至2022年5月陕西省核工业二一五医院收治的老年中段胸椎（T5～T9）OVCF合并退变性脊柱疾病患者105例，按入路方式不同将其分成研究组（63例）与对照组（42例）。对照组中男6例，女36例，年龄（76.81±5.74）岁，病程（12.51±4.72）d。研究组中男8例，女55例，年龄（76.27±5.93）岁，病程（12.93±4.30）d。研究组接受CT引导下改良PVP，对照组接受双侧经椎弓根入路椎体成形术。对比两组围手术期情况、疼痛情况、影像学参数、生物力学指标及并发症。统计学方法采用重复测量方差分析、独立样本t检验、χ²检验。结果　研究组手术时间比对照组长［（48.50±6.45）min比（37.13±5.32）min］，术中X线曝光次数、住院费用比对照组低［（17.35±2.59）次比（21.23±3.68）次、（1.91±0.28）万元比（2.45±0.37）万元］（均P<0.05）；两组术中出血量、骨水泥注入量、骨水泥分布情况、术后下地时间、住院时间对比差异均无统计学意义（均P>0.05）。术后1年，研究组和对照组的视觉模拟评分法（VAS）评分分别为（1.32±0.28）分和（1.39±0.31）分，低于术后1个月、术前（均P<0.05）。术后1年，研究组和对照组的伤椎前缘高度分别为（22.48±3.76）mm和（22.72±3.98）mm，伤椎后缘高度分别为（37.85±5.73）mm和（37.64±5.30）mm，高于术前、术后1个月（均P<0.05）；局部Cobb角分别为（10.14±1.78）°和（10.38±1.70）°，低于术前、术后1个月（均P<0.05）。对照组和研究组并发症总发生率比较差异无统计学意义［28.6%（12/42）比22.2%（14/63）］（P>0.05）。结论　老年中段胸椎（T5～T9）OVCF合并退变性脊柱疾病患者采用CT引导下改良PVP治疗效果确切，可改善患者生物力学功能，减轻疼痛程度，节省住院费用，但有一定的学习曲线。

关键词:

骨质疏松性椎体压缩骨折, 退变性脊柱疾病, 改良单侧椎弓根入路椎体成形术, 双侧经椎弓根入路椎体成形术

Abstract:

Objective　To investigate the effect of CT-guided modified unilateral pedicle approach vertebroplasty (PVP) in the treatment of senile patients with osteoporotic vertebral compression fracture (OVCF) of mid-thoracic vertebra (T5-T9) and degenerative spinal disease. Methods　A retrospective analysis was performed on 105 elderly patients with mid-thoracic vertebra (T5-T9) OVCF complicated with degenerative spinal disease admitted to Shaanxi Nuclear Industry 215 Hospital from February 2019 to May 2022. They were divided into a study group (63 cases) and a control group (42 cases) according to different approaches. In the control group, there were 6 males and 36 females, aged (76.81±5.74) years, and the course of disease was (12.51±4.72) d. In the study group, there were 8 males and 55 females, aged (76.27±5.93) years, and the course of disease was (12.93±4.30) d. The study group received modified CT-guided PVP, and the control group received bilateral transpedicle approach vertebroplasty. The perioperative conditions, pain, imaging parameters, biomechanical indexes, and complications were compared between the two groups. Repeated measure ANOVA, independent sample t test, and χ² test were used for statistical analysis. Results　The operation time of the study group was longer than that of the control group [(48.50±6.45) min vs. (37.13±5.32) min], and the intraoperative X-ray exposure times and hospitalization cost were lower than those of the control group [(17.35±2.59) times vs. (21.23±3.68) times, (1.91±0.28) million yuan vs. (2.45±0.37) million yuan] (all P<0.05). There was no statistically significant difference in the amount of blood loss, injection amount of bone cement, distribution of bone cement, postoperative ambulation time, or hospital stay between the two groups (all P>0.05). The Visual Analogue Scale (VAS) scores of the study group and the control group were (1.32±0.28) points and (1.39±0.31) points one year after surgery, which were lower than those before surgery and one month after surgery (all P<0.05); the anterior edge heights of the injured vertebra in the study group and the control group were (22.48±3.76) mm and (22.72±3.98) mm, and the posterior edge heights of the injured vertebra were (37.85±5.73) mm and (37.64±5.30) mm, which were higher than those before surgery and one month after surgery (all P<0.05); the local Cobb angles were (10.14±1.78)° and (10.38±1.70)°, which were lower than those before surgery and one month after surgery (all P<0.05). There was no statistically significant difference in the total incidence of complications between the control group and the study group [28.6% (12/42) vs. 22.2% (14/63)] (P>0.05). Conclusion　In elderly patients with mid-thoracic vertebrae (T5-T9) OVCF complicated with degenerative spinal disease, CT-guided modified PVP can effectively improve the biomechanical function, reduce the degree of pain, and save the hospitalization costs, but it has a certain learning curve.

Key words:

Osteoporotic vertebral compression fracture, Degenerative spinal disease, Modified unilateral pedicle approach vertebroplasty, Bilateral transpedicle approach vertebroplasty

张博张斌.

改良PVP治疗老年中段胸椎OVCF合并退变性脊柱疾病患者的效果 [J]. 国际医药卫生导报, 2025, 31(9): 1415-1420.

Zhang Bo, Zhang Bin.

Efficacy of modified PVP in the treatment of senile patients with mid-thoracic OVCF complicated with degenerative spinal disease [J]. International Medicine and Health Guidance News, 2025, 31(9): 1415-1420.

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改良PVP治疗老年中段胸椎OVCF合并退变性脊柱疾病患者的效果

Efficacy of modified PVP in the treatment of senile patients with mid-thoracic OVCF complicated with degenerative spinal disease

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