单侧与双侧椎体后凸成形术治疗多椎体骨质疏松性压缩骨折疗效分析

Unilateral versus bilateral balloon kyphoplasty in the treatment of multi-vertebral osteoporotic compression fractures

目的分析单侧与双侧球囊扩张椎体后凸成形术（KP）治疗多椎体骨质疏松性压缩骨折的疗效。方法对2002年5月至2007年6月，采用KP治疗并且获得1年以上随访的41例多椎体骨质疏松性压缩骨折患者，按手术是单侧或双侧进行分组。单侧手术组17例40个椎体，其中男性3例，女性14例；年龄52—91岁，平均70．4岁。双侧手术组24例53个椎体，其中男性4例，女性20例；年龄61—87岁，平均72．4岁。所有患者均在“C”型臂X线机引导下，经皮穿刺完成手术。术后观察症状改善、骨折复位及后凸矫正、并发症发生等情况，并进行统计学对比分析。结果所有患者手术均顺利完成。单侧手术组平均手术时间（86±32）min，平均每椎体注射骨水泥（3．9±1．6）ml，术后平均随访（32．5±17．2）个月；双侧手术组平均手术时间（120±26）min，平均每椎体注射骨水泥（5．4±2．1）ml，术后平均随访（30．7±14．3）个月。疼痛VAS评分：单侧手术组术前为7．4±2．1，术后为2．7±1．9，末次随访为3．1±2．2，手术前后差异有统计学意义（P〈0．05）；双侧手术组术前为7．9±2．1，术后为2．3±2．5，末次随访为2．7±2．2，手术前后差异有统计学意义（P〈0．05）。两组术后椎体前缘、中部高度均比术前有显著增加，且维持至末次随访，差异均有统计学意义（P〈0．05）。椎体后凸角单侧手术组平均矫正7．2°±4．9°，双侧手术组平均矫正7．3°±5．9°，各组手术前后比较，差异有统计学意义（P〈0．05）。而两组间上述各指标对应比较，差异无统计学意义。两组术后SF-36生命质量调查表8个领域中有6个显著提高。41例中发生骨水泥渗漏6例，肺栓塞1例。结论单侧或双侧KP治疗多椎体骨质疏松性压缩骨折均可获得满意的治疗效果。

Objective To comparatively study the efficacy and safety of unilateral and bilateral balloon kyphoplasty in the txeatment of painful multi-vertebral osteoporotic compression fractures. Methods From May 2002 to June 2007, 41 consecutive patients with painful multi-vertebral osteoporotic compression fractures underwent unilateral or bilateral kyphoplasty. The unilateral group included 3 male and 14 female with an average age of 70. 4 （range 52 to 91 years old）. The bilateral group included 4 men and 20 women with an average age of 72.4 （range 61 to 87 years old）. Each procedure included insertion of inflatable balloon, fracture reduction and cement filling under ＂C＂-arm monitoring. Preoperative and postoperative pain level, SF-36 score, radiographs and complications were recorded and analyzed. Results All 41 patients tolerated the operation well. The mean operation time were （86 ±32） rain and （120.±26） rain for unilateral and bilateral groups respectively ; the mean volume of cement injected into one level were （ 3.9 ± 1.6） ml and （ 5.4 ± 2. 1 ） ml for unilateral and bilateral groups respectively. The mean follow-up were （32. 5 ± 17.2） months and （30. 7 ± 14. 3） months for unilateral and bilateral groups respectively. The mean VAS pain score of unilateral group decreased significantly from 7.4 ± 2. 1 preoperatively to 2. 7 ± 1.9 postoperatively （ t = 2. 50, P 〈 0. 05 ） and 3.1 ± 2. 2 at final follow-up, the mean VAS pain score of bilateral group decreased significantly from 7. 9 ± 2. 1 preoperatively to 2. 3 ± 2. 5 postoperatively （ t = 2. 41, P 〈 0. 05 ） and 2. 7 ± 2. 2 at final follow-up, no significant difference was found between two groups. Significant increase of the mean height of anterior and medial vertebral body were recorded after the operation and maintained at final follow-up. The mean correction of local kyphosis was 7.2° ±4. 9° for unilateral group and 7.3 ° ± 5.9° for bilateral group, no significant difference was found between two groups. Postoperatively, 6 of 8 subscales measured by SF-36 were significantly improved for both groups. Complications were found in 7 patients including 6 cases of cement leakage and 1 case of pulmonary embolization. Conclusion As a minimally invasive procedure, unilateral or bilateral kyphoplasty is effective and relatively safe for multivertebral osteoporotic compression fracture.