单、双侧经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折的疗效

Outcomes of unilateral or bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures

目的:探讨经单侧或双侧椎弓根途径行椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩骨折的临床疗效。方法:回顾性分析2007年6月～2008年11月在我院行PKP治疗的97例(140个椎体)骨质疏松性椎体压缩骨折患者的临床资料,按术中经单侧或双侧椎弓根途径进行分组。单侧组均为单侧穿刺骨水泥注射过椎体中线者,共58例85个椎体,男13例,女45例,平均年龄65.3岁,单椎体36例,两椎体17例,三椎体5例。双侧组39例55个椎体,男5例,女34例,平均年龄67.1岁,单椎体24例,两椎体14例,三椎体1例。观察患者手术前后VAS评分变化、椎体平均高度、局部Cobb角改善及近远期并发症的发生情况。结果:所有患者均顺利完成手术。单侧组手术时间45±16min,骨水泥注入量3.1±1.7ml;双侧组手术时间62±27min,骨水泥注入量4.2±2.1ml,两组间比较有显著性差异(P<0.05);两组术后及末次随访时VAS评分均较术前明显降低(P<0.05),两组间比较差异无统计学意义(P>0.05);术后两组椎体平均高度及局部Cobb角较术前均有显著恢复(P<0.05),组间比较差异无显著性(P>0.05);单侧组骨水泥渗漏及邻近椎体再骨折的发生率为14.12%,双侧组为16.36%,差异亦无显著性(P>0.05)。结论:经单侧椎弓根途径穿刺骨水泥过椎体中线注射治疗骨质疏松性椎体压缩骨折可取得双侧穿刺同样满意的临床效果,且具有手术时间短、骨水泥渗漏率低等优点。

Objective：To compare the clinical outcomes of unilateral versus bilateral kyphoplasty for osteoporotic compression fracture.Method：97 cases（140 vertebrae） who sustained osteoporotic vertebral compression fracture and underwent percutaneous kyphoplasty from June 2007 to November 2008 were reviewed retrospectively.All cases were divided into two groups according to unilateral or bilateral approach.The unilateral group（58 patients,85 vertebraes） included 13 males and 45 females with an average age of 65.3（range,50-87 years old）,while 39 patients（55 vertebraes） were in the bipedicular group,who were 5 males and 34 females with an average age of 67.1（range,52-88 years old）.The visual analogue scale（VAS）,vertebral body height,Cobb′s angle at pre and post-operation and incidence of complications were used to observe the difference between 2 groups.Result：All patients underwent surgery successfully.The unilateral group had an average operative time of（45±16）min and an average of bone cement filling of（3.1±1.7）ml,while those for bilateral group were（45±16）min and（3.1±1.7）ml respectively.The VAS score decreased significantly after operation（P〈0.05）,but no significant difference were noted between 2 groups（P〉0.05）.Both groups had a significant recovery for average vertebral height and local Cobb′s angle（P〈0.05）,but no statistical significance were noted between them（P〉0.05）.As for the rate of cement leakage and adjacent vertebral fractures,unilateral group had 14.12% and bilateral group had 16.36%（P〉0.05）.Conclusion：Both unilateral or bilateral kyphoplasty are reliable for OVCFs,but unipedicular approach has the advantages of shorter operation time and lower bone cement leakage rate.