Karmakar Arnab, Acharya Suchi, Biswas Dibyendu, Sau Arkaprabha
Assistant Professor, Department of Orthopaedics, Institute of Post Graduate Medical Education and Research (IPGMER) and S.S.K.M. Hospital, Kolkata, West Bengal, India.
Senior Resident, Department of Paediatrics, Institute of Child Health, Kolkata, West Bengal, India.
J Clin Diagn Res. 2017 Aug;11(8):RC07-RC10. doi: 10.7860/JCDR/2017/25886.10461. Epub 2017 Aug 1.
INTRODUCTION: Osteoporotic vertebral compression fractures are a leading cause of disability and associated morbidities among Indian population. Worldwide, approximately 20% of elderly population above 70 years and 16% of postmenopausal women are suffering from it. Vertebral compression fractures should be aggressively treated with minimally invasive techniques such as Percutaneous Vertebroplasty (PVP) or Percutaneous Kyphoplasty (PKP) to minimize pain and disability associated with it. AIM: To evaluate the PVP in terms of pain reduction and restoration of functional abilities among the patients suffering from symptomatic osteoporotic vertebral compression fracture. MATERIALS AND METHODS: PVP using polymethyl methacrylate bone cement was performed between 2011 to 2013, on 25 patients admitted for symptomatic osteoporotic vertebral compression fracture in the Department of Orthopaedics, Institute of Post Graduate Medical Education and Research (IPGMER) and SSKM Hospital, Kolkata, West Bengal, India. All of them were followed up for one year. Pain and disability were evaluated with Visual Analogue Scale (VAS) and Oswestry Disability Questionnaire (ODQ) score respectively. Repeated measures ANOVA with Bonferroni post-hoc test was applied for significance testing. RESULTS: Reduction in pain was reported by 56% of patients within 10 minutes of operation. Mean VAS score at presentation was 8.24 (±1.16). It reduced to 6.31 (±1.21) and 2.38 (±0.08) at immediate postoperative period and after 12 months respectively. There was significant reduction (p<0.05) in pain, as measured by VAS score, started at immediate postoperative period to end of follow up period up to one year. Disability, measured by ODQ score, significantly decrease (p<0.05) over time from one week to 12-month postoperatively. At presentation, ODQ score was 93.01 (±4.54). It reduced to 76.84 (±3.76), one week after operation and 16.23 (±1.17), one year after operation. CONCLUSION: The PVP with polymethayl methacrylate bone cement is still a justified treatment procedure for osteoporotic vertebral compression fractures as it provides excellent pain relief, internal stability to the fractured vertebra thus preventing further collapse and progression of kyphosis, allowing the patients to regain normal activity at the earliest, and at a very reasonable cost with minimal complication.
引言:骨质疏松性椎体压缩骨折是印度人群致残及相关发病的主要原因。在全球范围内,约20%的70岁以上老年人口及16%的绝经后女性患有此病。椎体压缩骨折应采用经皮椎体成形术(PVP)或经皮后凸成形术(PKP)等微创技术积极治疗,以将与之相关的疼痛和残疾降至最低。 目的:评估经皮椎体成形术对有症状的骨质疏松性椎体压缩骨折患者在减轻疼痛及恢复功能能力方面的效果。 材料与方法:2011年至2013年期间,在印度西孟加拉邦加尔各答市研究生医学教育与研究学院(IPGMER)及SSKM医院骨科,对25例因有症状的骨质疏松性椎体压缩骨折入院的患者实施了使用聚甲基丙烯酸甲酯骨水泥的经皮椎体成形术。对所有患者进行了为期一年的随访。分别采用视觉模拟评分法(VAS)和奥斯维斯特残疾问卷(ODQ)评分评估疼痛和残疾情况。采用重复测量方差分析及Bonferroni事后检验进行显著性检验。 结果:56%的患者在术后10分钟内报告疼痛减轻。就诊时的平均VAS评分为8.24(±1.16)。术后即刻及12个月时分别降至6.31(±1.21)和2.38(±0.08)。从术后即刻至随访期结束长达一年,通过VAS评分测量的疼痛有显著减轻(p<0.05)。通过ODQ评分测量的残疾情况在术后一周至12个月随时间显著降低(p<0.05)。就诊时ODQ评分为93.01(±4.54)。术后一周降至76.84(±3.76),术后一年降至16.23(±1.17)。 结论:使用聚甲基丙烯酸甲酯骨水泥的经皮椎体成形术仍是治疗骨质疏松性椎体压缩骨折的合理治疗方法,因为它能有效缓解疼痛,为骨折椎体提供内在稳定性,从而防止进一步塌陷和后凸畸形进展,使患者能尽早恢复正常活动,且成本合理,并发症极少。
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