Role of Postural Reduction and Rehabilitation Guidance in the Treatment of Vertebral Osteoporotic Fractures by Vertebroplasty
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摘要:
目的 分析康复指导联合体位性复位在椎体后凸成形术治疗椎体骨质疏松性骨折中的作用。 方法 选取唐山市第二医院骨科2018年8月至2019年5月收治的68例椎体骨质疏松性骨折患者。随机分为联合组（n = 34，康复指导、体位性复位及椎体后凸成形术治疗）、常规组（n = 34，体位性复位与椎体后凸成形术治疗）。分析病人术前、术后3 d、3个月、0.5 a、1 a的椎体前缘高度、椎体后缘高度、椎体临近矢状面局部Cobb角、视角模拟疼痛（VAS）评分及相关并发症发生情况。 结果 术后椎体前缘高度均高于术前，（P < 0.05），术后12个月联合组术后椎体前缘高度均高于常规组，（P < 0.05）；术后椎体后缘高度高于术前，（P < 0.05），组间无差异（P > 0.05）。2组术后椎体临近矢状面局部Cobb角低于术前（P < 0.05），组间无差异（P > 0.05）；术前VAS评分高于术后（P < 0.05），术后3 d、3个月、0.5 a的VAS评分常规组高于联合组（P < 0.05），术后1 a VAS评分组间无差异（P > 0.05）；联合组并发症发生率（8.82%）低于常规组（17.65%），（P < 0.05）。 结论 在治疗椎体骨质疏松性骨折过程中，科学、充分的康复指导能够有效减轻患者疼痛，降低并发症发生率。 Abstract:Objectives To analyze the role of rehabilitation guidance combined position reduction in kyphoplasty for osteoporotic vertebral fractures. Methods A total of 68 patients with vertebral osteoporotic fractures admitted to our hospital from August 2018 to May 2019 were selected. They were randomly divided into two groups: combined group （n = 34, rehabilitation guidance combined position reduction and kyphoplasty） and conventional group （n = 34, position reduction and kyphoplasty）. The anterior and posterior vertebral height, local Cobb Angle near the sagittal plane of the vertebral body, visual analogue pain （VAS） score and related complications were analyzed before and after surgery at 3 d, 3 months, 0.5 and 1 year. Results The height of anterior vertebral margin after surgery was higher than that before surgery （P < 0.05）, and the height of anterior vertebral margin after 12 months in combined group was higher than that in conventional group （P < 0.05）. The height of posterior margin of vertebral body after operation was higher than that before operation （P < 0.05）, and there was no difference between groups （P > 0.05）. The local Cobb Angle of vertebral body near sagittal plane after operation was lower than that before operation （P < 0.05）, and there was no difference between the two groups （P > 0.05）. The preoperative VAS score was higher than that of the postoperative group （P < 0.05）, the VAS score of the conventional group was higher than that of the combined group at 3, 3 and 0.5 months after surgery （P < 0.05）, and there was no difference among groups in THE VAS score at 1 year after surgery （P > 0.05）. The complication rate of combined group （8.82%） was lower than that of conventional group （17.65%） （P < 0.05）. Conclusions In the treatment of vertebral osteoporotic fracture, scientific and adequate rehabilitation guidance can effectively relieve pain and reduce the incidence of complications. -
表 1 椎体前缘高度比较（
$\bar x \pm s $ ，mm）Table 1. Comparison of anterior margin height of vertebral body （
$\bar x \pm s $ ，mm）组别 n 术前 术后3 d 术后3个月 术后6个月 术后12个月 t p 常规组 34 18.32 ± 2.34 23.35 ± 1.20* 22.32 ± 1.19* 22.27 ± 1.19* 21.24 ± 1.15* 5.432 0.013 联合组 34 18.28 ± 1.58△ 23.66 ± 1.21△ 23.58 ± 1.21△ 23.26 ± 1.20△ 23.22 ± 1.17△ 5.217 0.014 t 0.114 0.457 2.461 3.132 5.671 P 0.916 0.978 0.121 0.075 0.043 与术前比较，*P < 0.05；与常规组比较，△P < 0.05。 
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表 2 椎体后缘高度比较（
$\bar x \pm s $ ，mm）Table 2. Comparison of posterior margin height of vertebral body （
$\bar x \pm s $ ，mm）组别 n 术前 术后3 d 术后3个月 术后6个月 术后12个月 t p 常规组 34 18.62 ± 2.94 22.85 ± 2.73* 22.12 ± 2.89* 21.77 ± 2.19* 21.24 ± 2.15* 4.571 0.041 联合组 34 18.68 ± 2.98△ 22.83 ± 2.71△ 22.80 ± 2.91△ 22.76 ± 2.20△ 22.77 ± 2.17△ 4.817 0.036 t 0.112 0.048 1.233 2.167 2.713 P 0.921 0.971 0.214 0.141 0.067 与术前比较，*P < 0.05；与常规组比较，△P < 0.05。
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表 3 2组术前术后椎体临近矢状面局部Cobb角对比（
$\bar x \pm s $ ，°）Table 3. Comparison of local Cobb angle of vertebral body near sagittal plane between two groups before and after operation （
$\bar x \pm s $ ，°）组别 n 术前 术后3 d 术后3个月 术后6个月 术后12个月 t p 联合组 34 22.82 ± 1.32 10.85 ± 1.21* 10.05 ± 1.25* 11.27 ± 1.29* 11.28 ± 1.15* 6.432 0.009 常规组 34 22.78 ± 1.08 10.89 ± 1.00 11.01 ± 0.99 11.26 ± 1.01 11.32 ± 0.97 6.216 0.010 t 0.256 0.051 0.092 0.032 0.034 P 0.813 0.961 0.935 0.979 0.980 与术前比较，*P < 0.05。
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表 4 VAS评分比较[（
$\bar x \pm s $ ），分]Table 4. Comparison of VAS scores [（
$\bar x \pm s $ ，score）]组别 n 术前 术后3 d 术后3个月 术后6个月 术后12个月 t p 联合组 34 8.12 ± 0.32 2.45 ± 0.21* 1.75 ± 0.25* 1.57 ± 0.22* 1.48 ± 0.15* 9.932 0.000 常规组 34 8.11 ± 0.28 3.89 ± 0.34* 2.81 ± 0.29* 2.36 ± 0.21* 1.82 ± 0.17* 8.776 0.001 t 0.042 3.351 2.692 2.532 0.033 P 0.973 0.027 0.031 0.034 0.983 与术前比较，*P < 0.05。
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