PKP聯合脈沖電治療在老年OVCF中的應用效果

譚偉源　鄺立鵬

【摘要】 目的：探討經皮椎體后凸成形術（percutaneous kyphoplasty，PKP）聯合術后脈沖電治療在老年骨質疏松性椎體壓縮性骨折（osteoporotic vertebral compression fractures，OVCF）中的應用效果。方法：選取2014年6月-2017年12月于本院行PKP的148例老年OVCF患者為研究對象。按照隨機數字表法患者分為高黏度PKP組（A組）、低黏度PKP組（B組）、高黏度PKP聯合脈沖電治療組（C組）和低黏度PKP聯合脈沖電治療組（D組），各37例。觀察并對比四組患者的手術情況、治療前后的視覺模擬評分法（visual analogue scale，VAS）評分、骨折椎體后凸Cobb角、Oswestry功能障礙指數（Oswestry disability index，ODI）及腰椎骨密度，統計四組術后骨水泥滲漏及并發癥發生情況。結果：治療后1、3、12個月，四組患者的VAS評分均較治療前明顯降低（P<0.05），C組治療后1、3、12個月的VAS評分均低于A組（P<0.05），D組治療后1、3、12個月的VAS評分均低于B組（P<0.05）。治療后1、12個月，四組患者的ODI均較術前明顯降低（P<0.05），C組治療后1、12個月的ODI評分均低于A組（P<0.05），D組治療后1、12個月的ODI均低于B組（P<0.05）。四組患者于治療后1、12個月Cobb角均較術前明顯降低（P<0.05）。A、B組患者治療后3、12個月的腰椎骨密度與治療前比較，差異均無統計學意義（P>0.05），而C、D組患者治療后3、12個月的腰椎骨密度均較治療前明顯增加（P<0.05）;C組治療后3、12個月的骨密度均高于A組（P<0.05），D組治療后3、12個月的骨密度均高于B組（P<0.05）。A組的骨水泥靜脈滲漏率、椎間滲漏率、椎旁滲漏率均明顯低于B組，C組的骨水泥靜脈滲漏率、椎間滲漏率、椎旁滲漏率均明顯低于D組（P<0.05）。結論：PKP治療老年骨質疏松椎體壓縮骨折具有良好的效果，使用高黏度骨水泥進行PKP治療術后滲漏率更低，同時聯合術后脈沖電治療可更有效緩解疼痛，提高骨密度，改善患者腰背部功能障礙。

【關鍵詞】 骨質疏松椎體壓縮骨折; 經椎體后凸成形術; 骨水泥; 脈沖

【Abstract】 Objective：To explore the application effect of percutaneous kyphoplasty（PKP）combined postoperative pulse therapy in elderly osteoporotic vertebral compression fractures（OVCF）.Method：148 elderly patients with OVCF who underwent PKP in our hospital from June 2014 to December 2017 were selected as subjects.According to the random number table method，the subjects were divided into high-viscosity PKP group（group A），low-viscosity PKP group（group B），high-viscosity PKP combined with pulse electrotherapy group（group C）and low-viscosity PKP combined with pulse electrotherapy group（group D），37 cases in each group.The operation condition，visual analogue score，Cobb angle of kyphosis，Oswestry dysfunction index and lumbar vertebral bone mineral density before and after treatment were observed and compared among the four groups，postoperative cement leakage and complications were counted among the four groups.Result：At 1，3 and 12 months after treatment，the VAS scores of the four groups were significantly lower than those before treatment（P<0.05），the VAS scores of group C at 1，3 and 12 months after treatment were lower than those of group A（P<0.05），the VAS scores of group D at 1，3 and 12 months after treatment were lower than those of group B（P<0.05）.At 1 month and 12 months after treatment，the ODI scores of the four groups were significantly lower than those before treatment（P<0.05），the ODI scores of group A were lower than those of group C at 1 month and 12 months after treatment（P<0.05），while that of group D at 1 month and 12 months after treatment were lower than those of group B（P<0.05）.Cobb angle of four groups were significantly lower than those before treatment at 1 month and 12 months after treatment（P<0.05）;there were no significant differences in lumbar BMD between group A and group B at 3 months and 12 months after treatment（P>0.05），while there were no significant differences between group C and group D at 3 and 12 months after treatment（P<0.05）.The bone mineral density of lumbar spine in group C were higher than those in group A at 3 and 12 months after treatment（P<0.05），and those in group D at 3 and 12 months after treatment were higher than those in group B（P<0.05）.The leakage rate of bone cement vein，intervertebral leakage rate and paravertebral leakage rate in group A were lower than those in group B，the rates of mud vein leakage，intervertebral leakage and paravertebral leakage in group C were significantly lower than those in group D（P<0.05）.Conclusion：PKP is effective in the treatment of osteoporotic vertebral compression fractures in the elderly，the leakage rate after PKP treatment with high-viscosity bone cement is lower，at the same time，combined with post-operative pulsed electric therapy can more effectively relieve pain，improve bone mineral density and improve the lumbar and back dysfunction of patients.