摘要
目的 观察穿刺针联合经皮椎体成形术(PVP)在老年脆性腰椎椎体压缩性骨折治疗中的临床价值.方法 回顾性收集2021年1月至2022年12月安康市中心医院择期手术治疗的156例老年脆性腰椎椎体压缩性骨折患者,根据手术治疗方法不同分为观察组(n=78)和对照组(n=78).观察组采用穿刺针联合PVP手术,对照组单纯采用PVP手术.对比分析两组患者围手术期指标(手术时间、术中出血量、术后下床时间以及住院时间),术前、术后3 d的椎体结构影像学指标,术前、术后3 d、术后6个月的疼痛视觉模拟评分法(VAS)评分,术前、术后6个月的腰椎功能[日本矫形学学会(JOA)]评分、日常生活能力Barthel指数.结果 观察组患者的手术时间为(98.16±11.97)min,明显长于对照组[(85.86±10.5)min],术中出血量、术后下床时间以及住院时间分别为(79.37±18.96)mL、(3.04±0.37)d、(10.41±2.06)d,均明显短于对照组[(184.43±21.25)mL、(4.22±0.43)d、(12.97±2.36)d],差异均有统计学意义(P＜0.05).术后3 d,两组患者的椎体各部位高度均明显高于术前,局部Cobb角均明显低于手术前,且观察组患者的椎体前缘、中部、后部高度分别为(30.69±4.15)、(35.84±3.77)、(38.92±4.86)mm,均明显高于对照组[(26.62±4.27)、(28.97±3.62)、(32.33±4.53)mm],局部 Cobb 角为(5.41±1.25)°,明显低于对照组[(8.69±1.39)°],差异均有统计学意义(P＜0.05).术后3 d与术后6个月,两组患者的VAS评分均明显低于术前,且观察组患者的VAS评分分别为(2.29±0.24)、(2.18±0.27)分,均明显低于对照组[(3.35±0.41)、(3.07±0.34)分],差异均有统计学意义(P＜0.05).术后6个月,两组患者的JOA评分与Barthel指数均明显高于术前,且观察组患者的JOA评分与 Barthel 指数分别为(25.28±2.24)、(84.05±5.97)分,均明显高于对照组[(21.42±2.13)、(55.94±6.28)分],差异均有统计学意义(P＜0.05).结论 穿刺针联合PVP治疗老年脆性腰椎椎体压缩性骨折虽然手术时间延长,但创伤小且恢复快,能够更有效纠正椎体解剖结构,缓解术后疼痛,提升术后腰椎与活动能力,临床价值更高,更加符合老年脆性腰椎椎体压缩性骨折以及现代医学理念的要求.
Abstract
Objective To observe the clinical value of puncture needle combined with percutaneous vertebroplasty(PVP)in elderly pa-tients with fragile lumbar vertebral compression fractures.Methods Retrospective data were collected from 156 elderly patients with fragile lumbar vertebra compression fracture treated by elective surgery in Ankang Central Hospital from January 2021 to December 2022.According to different surgical treatment methods,they were divided into observation group(n=78)and control group(n=78).The observation group received puncture needle combined with PVP surgery,and the control group received PVP surgery.Intraoperative and postoperative recovery evaluation in-dexes(operation time,intraoperative blood loss,postoperative ambulation time and hospitalization time),the imaging indexes of vertebral structure before operation and 3 days after operation,the pain visual analogue scale(VAS)score before operation,3 days after operation and 6 months after operation,the Japanese Orthopaedic Association(JOA)score of lumbar function and the Barthel index of daily living ability before operation and 6 months after operation of the two groups were analyzed and compared.Results The operation time of the observation group was(98.16±11.97)min,which was significantly longer than that of the control group[(85.86±10.5)min],the intraoperative blood loss,postoperative ambulation time and hospitalization time were(79.37±18.96)mL,(3.04±0.37)d and(10.41±2.06)d,respectively,which were significantly shorter than those of the control group[(184.43±21.25)mL,(4.22±0.43)d and(12.97±2.36)d],and the differences were statistically signifi-cant(P＜0.05).At 3 days after operation,the height of each part of the vertebral body in the two groups was significantly higher than that before operation,and the local Cobb angle was significantly lower than that before operation,the anterior,middle and posterior heights of the vertebral body in the observation group were(30.69±4.15),(35.84±3.77)and(38.92±4.86)mm,respectively,which were significantly higher than those in the control group[(26.62±4.27),(28.97±3.62)and(32.33±4.53)mm],and the local Cobb angle was(5.41±1.25)°,which was significantly lower than that in the control group[(8.69±1.39)°],the differences were statistically significant(P＜0.05).At 3 days and 6 months after operation,the VAS scores of the two groups were significantly lower than those before operation,and the VAS scores of the observation group were(2.29±0.24)and(2.18±0.27)points,respectively,which were significantly lower than those of the control group[(3.35±0.41)and(3.07±0.34)points],the differences were statistically significant(P＜0.05).At 6 months after operation,the JOA and Barthel index of the two groups were significantly higher than those before operation,and the JOA and Barthel index of the observation group were(25.28±2.24)and(84.05±5.97),respectively,which were significantly higher than those of the control group[(21.42±2.13)and(55.94±6.28)],the differences were statistically significant(P＜0.05).Conclusion Puncture needle combined with PVP can prolong the treatment time of fragile lumbar vertebral compression fractures in the elderly,but with less trauma and faster recovery,it can more effectively cor-rect the vertebral anatomy,relieve postoperative pain,improve postoperative lumbar spine and mobility,and has higher clinical value,which is more in line with the requirements of fragile lumbar vertebral compression fractures in the elderly and modem medical concepts.
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