双球囊与单球囊椎体后凸成形术治疗骨质疏松性脊柱压缩骨折的临床对照研究

Percutaneous kyphoplasty with double or single balloon in treatment of osteoporotic vertebral body compressive fracture： a clinical controlled study

目的评价双球囊与单球囊椎体后凸成形术治疗骨质疏松性脊柱压缩骨折的临床价值。方法51例疼痛性骨质疏松脊柱压缩骨折患者，累及椎体69个。在X线监测下，经双侧椎弓根穿刺伤椎，完成球囊扩张，骨水泥填充。双球囊组患者29例（38个椎体），应用双球囊在椎体内双侧同时协调扩张；单球囊组患者22例（31个椎体），应用单球囊双侧入路在椎体内先后交替扩张。比较术前与术后椎体高度与Cobb角的差异，并分别计算两组的术后椎体高度平均恢复率和与Cobb角平均矫正度，比较两组之间差异，并随访6～12个月。结果51例患者手术顺利，术后第96小时内疼痛均明显缓解，无临床并发症。患者10分制视觉模拟疼痛评分法评分由术前平均7．7分降至术后2．6分（P〈0．01）；Oswestry功能障碍指数评分由术前平均73％降至术后26％（P〈0．01）。双球囊组伤椎椎体前缘和中部平均丢失高度由术前14．7mm和10．5mm改善至术后10．1mm和5．5mm，Cobb角由术前平均22.4°，矫正至术后12．3°，手术前后差异具有显著性意义（P〈0.01）；单球囊组伤椎椎体前缘和中部平均丢失高度由术前14．7mm和10．6mm，改善至术后10．4mm和6．5mm，Cobb角由术前平均21．2°，矫正至术后11．6°，手术前后差异具有显著性意义（P〈0．01）。双球囊组与单球囊组术后椎体平均高度恢复率分别为72．8％、70．1％，Cobb角平均矫正度分别为10．1°和9．5°，两组相比差异无统计学意义（P〉0．05）。随访期间，无疼痛加重病例出现。结论双球囊与单球囊椎体后凸成形术治疗老年骨质疏松脊柱压缩骨折均可获得满意疗效。

Objective To evaluate the clinical efficacy of percutaneous bipedicular kyphoplasty with double or single balloon Ⅰ treatment of osteoporosis vertebral compressive fractures. Methods Fifty-one patients with painful osteoporotic vertebral compressive fracture involving 69 vertebrae. 19 males and 32 females, aged 72. 5 （63-85） , underwent percutaneous kyphoplasty with double inflatable balloon （29cases, 38 vertebrae） or single inflatable balloon （22 cases, 31 vertebrae） under X-ray fluoroscopy monitoring. The fractured vertebral bodies were punctuated, balloon was put into the subsided areas and then distended, and bone cement was injected into the cavity. The vertebral height and Cobb angle, preoperative and postoperative, were measured by radiography. Follow-up was conducted for 6-12 months. Results All patients tolerated the procedure well with dramatic pain relief within 96 hours after the procedure. No clinical complication was found. Visual analog scale score was improved from 7.8 preoperatively to 2. 6 postoperatively （ P 〈 0. 01 ） . Oswestry disability index was decreased from 73% preoperatively to 26% postoperatively. In the double balloon group, the heights loss of the anterior and middle portions of the vertebral body reduced from 14.7 mm and 10. 5 mm to 10. 1 mm and 5.5 mm respectively（ both P 〈 0. 01 ） , and the Cobb angle was corrected from 22.4° to 12.3°（P 〈0. 01）. In the single balloon group, the heights loss of the anterior and middle portions of the vertebral body reduced from 14. 7 mm and 10. 6 mm to 10. 4 mm and 6. 5 mm respectively（both P 〈 0. 01 ） , and the. Cobb angle was corrected averagely from 21.2°to 11.6° （ P 〈 0. 01 ）. The mean vertebral height restoration rates were 72. 8 % and 70. 1% in the double and single balloon groups respectively. The mean Cobb angle correct degrees were 10. 1 °and 9.5°in double and single balloon groups respectively. There were no significant differences in the average height restoration rate and Cobb angle correction between the double and single balloon groups （72. 8% vs 70. 1% , and 10. 0° vs 9. 5° both P 〉 0. 05 ）. The pain relief and functional recovery were substantial and maintained to the last follow up. Conclusion Percutaneous bipedicular kyphoplasty with double or single balloon for painful osteoporotic vertebral body compressive fractures is effective and safe.