双侧与单侧PKP治疗骨质疏松性椎体压缩性骨折

Comparison of the clinical effects of bilateral and unilateral percutaneous kyphoplasty in treating osteoporotic vertebral compression fracture

目的比较双侧与单侧经椎弓根穿刺椎体后凸成形术治疗骨质疏松性椎体压缩性骨折的疗效。方法 2005-05-2010-03,应用经皮球囊扩张椎体后凸成形术治疗62例骨质疏松性椎体压缩性骨折患者,其中32例经双侧椎弓根穿刺,30例经单侧椎弓根穿刺,按照VAS评分、影像学资料、Oswestry评分标准分别对患者疼痛、椎体高度和Cobb’s角、日常活动功能进行疗效比较。结果所有手术均顺利完成,无严重手术并发症。有7个椎体发生骨水泥渗漏,均未出现临床症状。术后1周、1年时,两种穿刺方法椎体前缘高度、椎体后凸Cobb’s角、VAS评分及Oswestry功能评分较术前均有改善(P<0.05)。术后1周与最终随访时差异无统计学意义(P>0.05)。术后1周双侧组与单侧组比较,伤椎前缘的高度、椎体后凸Cobb角、VAS评分有显著性差异(P<0.05),最终随访两者疼痛恢复无显著性差异(P>0.05)。结论两种不同穿刺方法治疗骨质疏松性椎体压缩性骨折均是安全有效的;伤椎前缘高度的恢复、椎体后凸Cobb角及早期VAS评分的改善方面,双侧穿刺组优于单侧穿刺组。

Objective To compare the clinical effects of bilateral and unilateral percutaneous kyphoplasty in treating osteoporotic vertebral compression fracture.Methods From May 2005 to March 2010,62 patients with osteoporotic vertebral compression fracture were treated with percutaneous kyphoplasty,of them,32 cases with bilateral and 30 cases with unilateral.The pain,height of vertebral body and Cobb＇s angle,function of daily activities were compared by VAS scoring,iconography data,Oswestry index between bilateral group and unilateral group.Results All operations were successful,no severe complication.Happend in seven vertebral bodies,bone cement leakage,but no clinical symptoms were found.At the first week and the first year after operation,the height of vertebral body,Cobb＇s angle,VAS soring and Oswestry index improved significantly than preoperation between two groups（P0.05）.There was no significant difference between the 1st week after operation and final follow-up.At the 1st week after operation,there was significant difference in the height of vertebral body,Cobb＇s angle,VAS soring between two groups（P0.05）;and at final follow-up,there was no significant difference in VAS between two groups（P0.05）.Conclusion Bilateral and unilateral paracentesis both are safe and effective in treating osteoporotic vertebral compression fracture.Bilateral percutaneous kyphoplasty are better than unilateral in aspect of recovery of height of vertebral body,improvement of Cobb＇s angle and early VAS scoring.