老年骨质疏松性椎体压缩骨折的手术适应证及疗效对比研究进展

Research Progress on Surgical Indications and Comparative Efficacy of Osteoporotic Vertebral Compression Fractures in the Elderly

摘要: 老年骨质疏松性椎体压缩骨折(OVCF)是老龄化社会中的常见骨科疾病，常导致严重疼痛、脊柱畸形及功能受限，显著降低患者生活质量。本文系统介绍了OVCF的评估与诊断方法，重点对比了保守治疗与手术治疗的适应证，并深入探讨了经皮椎体成形术(PVP)与球囊扩张椎体成形术(PKP)的疗效、并发症及风险管理。保守治疗适用于症状轻微、骨折稳定的患者，而顽固性疼痛、进行性后凸畸形或神经功能症状则是手术干预的主要指征。PVP和PKP均能有效缓解疼痛、稳定椎体，但PKP在恢复椎体高度和纠正后凸畸形方面更具优势。尽管椎体增强术总体安全，但骨水泥渗漏、邻近椎体骨折及感染等并发症仍需警惕。现有研究在随机对照试验设计、样本量、随访时长及结局指标评估上存在局限性。未来需开展更高质量、更长随访期的研究，并探索新型骨水泥材料、优化手术技术及整合康复管理策略，以进一步提升OVCF患者的整体预后。

Abstract: Osteoporotic vertebral compression fractures (OVCFs) are common orthopedic diseases in an aging society, often causing severe pain, spinal deformity, and functional limitations, significantly reducing patients’ quality of life. This article systematically presents the assessment and diagnostic approaches for OVCFs, with a focus on comparing the indications for conservative treatment versus surgical intervention, and provides an in-depth discussion on the efficacy, complications, and risk management of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP). Conservative treatment is suitable for patients with mild symptoms and stable fractures, whereas intractable pain, progressive kyphotic deformity, or neurological symptoms are the main indications for surgical intervention. Both PVP and PKP can effectively relieve pain and stabilize the vertebral body, but PKP has advantages in restoring vertebral height and correcting kyphotic deformity. Although vertebral augmentation procedures are generally safe, complications such as bone cement leakage, adjacent vertebral fractures, and infections still require vigilance. Existing studies have limitations in randomized controlled trial design, sample size, follow-up duration, and outcome measures. Future research should involve higher-quality studies with longer follow-up periods, explore novel bone cement materials, optimize surgical techniques, and integrate rehabilitation management strategies to further improve the overall prognosis of OVCF patients.