单侧与双侧椎体后凸成形术治疗骨质疏松性椎体压缩骨折

Unilateral versus bilateral balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures

目的:探讨单侧与双侧穿刺行球囊扩张椎体后凸成形术(balloon kyphoplasty,BKP)治疗骨质疏松性椎体压缩骨折的疗效。方法:回顾性分析67例行单侧或双侧BKP治疗的骨质疏松性椎体压缩骨折患者的临床资料。患者术前均无神经损伤症状。单侧BKP组27例27个椎体,其中男11例,女16例,年龄为62.3±7.4岁;T10 2个,T11 2个,L1 5个,L2 7个,L3 7个,L4 3个,L5 1个。双侧BKP组40例40个椎体,其中男17例,女23例,年龄68.5±5.7岁;T9 3个,T10 7个,T11 6个,T12 3个,L1 5个,L2 6个,L3 7个,L4 3个。比较两组手术时间、术中C型臂X线曝光次数、并发症以及手术后末次随访时伤椎椎体前缘与中间高度恢复值、VAS评分改善率。结果:单侧BKP组与双侧BKP组的手术时间分别为40±18min、65±25min,有统计学差异(P<0.05);X线曝光次数单侧组与双侧组分别为36±13次、63±21次,有统计学差异(P<0.05)。骨水泥渗漏率单侧组与双侧组分别为11.1%、12.5%,无统计学差异(P>0.05)。单侧组与双侧组患者随访时间分别为14.7±4.5个月与14.3±5.2个月。术后非手术椎体骨折发生率单侧组与双侧组分别为3.7%、5%,无统计学差异(P>0.05)。末次随访时,单侧组与双侧组椎体前缘高度恢复值分别为(29.0±14.7)%、(34.2±17.8)%,椎体中间高度恢复值分别为(24.5±17.9)%、(30.8±21.1)%,VAS评分改善率分别为(75±9)%、(73±7)%,均无统计学差异(P>0.05)。结论:单侧BKP与双侧BKP治疗骨质疏松性椎体压缩骨折均安全有效,单侧BKP与双侧BKP比较具有手术时间短、术中X线辐射剂量小的优点。

Objective：To evaluate the efficacy of unilateral versus bilateral balloon kyphoplasty（BKP） for osteoporotic vertebral compression fractures（OVCFs）.Method：The clinical data of 67 patients with OVCFs without nerve deficit undergoing either unilateral or bilateral BKP were analyzed retrospectively.27 cases underwent unilateral BKP,including 11 males and 16 females with the age of 62.3±7.4 years.There were 2 T10,2 T11,5 L1,7 L2,7 L3,3 L4 and 1 L5.While 40 cases underwent bilateral BKP,including 17 males and 23 females,with the age of 68.5 years ± 5.7 years.There were 3 T9,7 T10,6 T11,3 T12,5 L1,6 L2,7 L3 and 3 L4.The operation time,X ray exposure times,complications,anterior and middle vertebral height restoration and VAS scores improvement at final follow-up after operation between unilateral and bilateral BKP were compared.Result：The mean operative time was 40±18min in unilateral BKP group and 65±25min in bilateral BKP group,there was statistically significant difference（P〈0.05）.The average X-ray exposure times were（36±13） times in unilateral BKP group and（63±21） times in bilateral BKP group（P〈0.05）.The cement leakage rate was 11.1% in unilateral BKP group and 12.5% in bilateral BKP group（P〉0.05）.The fracture rate of non-surgical vertebra after BKP was 3.7% in unilateral BKP group and 5% in bilateral BKP group（P〉0.05）.The mean follow-up was（14.7±4.5） months for unilateral BKP group and（14.3±5.2） months for bilateral BKP group.At final follow-up,the anterior vertebral height restoration rate was（29.0±14.7）% in unilateral BKP group and（34.2±17.8）% in bilateral BKP group（P〉0.05）,the middle vertebral height restoration rate was（24.5±17.9）% for unilateral BKP group and（30.8±21.1）% for bilateral BKP group（P〉0.05）;VAS improvement rate was（75±9）% in unilateral BKP group,（73±7）% in bilateral BKP group（P〉0.05）.Conclusion：Unilateral and bilateral BKP remain a reliable and effective treatment for OVCFs.Compared with bilateral BKP,unilateral BKP is of less operation time and less X ray exposure.