Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama City, Toyama 930-0194, Japan.
Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama City, Toyama 930-0194, Japan.
Spine J. 2014 Jan;14(1):39-48. doi: 10.1016/j.spinee.2013.03.016. Epub 2013 Apr 23.
There has been no study regarding the comparison between vertebroplasty and conservative treatment for osteoporotic burst fracture.
To compare the results of vertebroplasty after intravertebral cavity formation with that of conservative treatment alone.
A case-control study.
The vertebroplasty group included 40 consecutive patients with primary osteoporotic burst fracture who underwent vertebroplasty using calcium phosphate cement, and the control group was made up of 40 patients given conservative treatment alone who were matched for age, gender, the injury level, and the type of fracture. Two groups of patients who had no neural deficit were prospectively examined. Clinical and radiological outcomes of these two groups were compared blindly. The authors do not report any conflict of interest in this study.
Outcome measures included visual analog scale (VAS) of the back pain, analgesic requirements, and mobility; in a lateral radiograph, the deformity index was measured and expressed as the ratio of the vertebral body (VB) height (sum of measurements at anterior, middle, and posterior regions of VB) to the longitudinal diameter of VB. Anteroposterior height comparison was expressed as the percentage of VB height at the anterior region compared with the height at the posterior region. Each recovery rate was calculated as a percentage by the formula: (value at the examination-value before treatment)/value before treatment × 100.
The duration of follow-up was more than 12 months (mean; 22.5 months). The mean VAS at 12 months after injury was 2.17 cm in the conservative group and 0.61 cm in the vertebroplasty group (p=.0002). The mean duration of analgesic medication required was 157.2 days in the conservative group and 21.3 days in the vertebroplasty group (p=.0048). The mean deformity index at 12 months after injury was 1.66 in the vertebroplasty group and 1.38 in the control group, and the mean recovery rate was +7.3% and -18.4%, respectively (p<.0001). Anteroposterior height comparison at 12 months after injury was 49.1% in the conservative group and 71.2% in the vertebroplasty group, and the mean recovery rate was -26.4% and +30.1%, respectively (p<.0001). One fracture in the vertebroplasty group showed delayed union until 6 months after injury. In the control group, there were six delayed union including four pseudoarthroses at over 6 months after injury that caused leg pain and were treated by conservative therapy.
We conclude that vertebroplasty after intravertebral cavity formation provided a better clinical and radiological result than conservative treatment for osteoporotic burst fracture.
目前还没有研究比较过椎体成形术与保守治疗在骨质疏松性爆裂性骨折中的疗效。
比较经皮椎体成形术治疗骨质疏松性爆裂性骨折的疗效与单纯保守治疗的疗效。
病例对照研究。
椎体成形术组纳入 40 例初次发生骨质疏松性爆裂性骨折的患者，使用磷酸钙骨水泥进行椎体成形术治疗，对照组纳入 40 例单纯接受保守治疗且年龄、性别、损伤节段和骨折类型相匹配的患者。两组无神经缺损的患者均进行前瞻性检查。两组的临床和影像学结果由盲法进行比较。作者声明在本研究中不存在利益冲突。
随访时间均超过 12 个月（平均 22.5 个月）。保守治疗组受伤后 12 个月时的平均视觉模拟评分（VAS）为 2.17cm，椎体成形术组为 0.61cm（p=.0002）。保守治疗组需要止痛药的平均持续时间为 157.2 天，椎体成形术组为 21.3 天（p=.0048）。受伤后 12 个月时，椎体成形术组的平均畸形指数为 1.66，对照组为 1.38，椎体成形术组的平均恢复率为+7.3%，对照组为-18.4%（p<.0001）。受伤后 12 个月时，保守治疗组的前后位高度比为 49.1%，椎体成形术组为 71.2%，椎体成形术组的平均恢复率为-26.4%，对照组为+30.1%（p<.0001）。椎体成形术组有 1 例骨折延迟愈合，直至受伤后 6 个月。对照组中，有 6 例骨折延迟愈合，其中 4 例在受伤后 6 个月以上出现假关节，导致腿部疼痛，采用保守治疗。
我们的结论是，经皮椎体成形术治疗骨质疏松性爆裂性骨折的临床和影像学疗效优于保守治疗。
