两种不同方式经皮椎体后凸成形术治疗骨质疏松性胸腰椎压缩骨折效果的比较

Comparison of two surgical modalities of percutaneous kyphoplasty in treatment of osteoporotic thoracolumbar vertebral compressionfractures

目的探讨两种不同方式经皮椎体后凸成形术（PKP）治疗骨质疏松性胸腰椎压缩骨折的临床效果。方法对56例骨质疏松性胸腰椎压缩骨折患者采用球囊式椎体扩张器注射扩张病椎，并用骨水泥进行填充。A组21例在全麻下俯卧位通过椎弓根进行双侧注射，B组35例在局麻下侧卧位经椎弓根进行单侧注射。对两组患者的疼痛程度（采用疼痛视觉模拟评分法即VAS评定）、手术前后椎体高度变化、手术时间、住院费用等进行比较，以评价两种手术方式效果的差异。结果两组患者均顺利完成手术，无严重手术并发症。A组VAS评分由术前的（8．63±0．91）分下降至术后的（171±1．35）分，B组患者由术前的（8．67±0．93）分下降至术后的（169±1．33）分，两组间的差异无统计学意义（P〉0．05）。A组术前椎体前缘平均高度为（13．30±2．340）mm，术后为（23．32±2．40）mm；术前椎体后缘平均高度为（22．13±2．11）mm，术后为（23．59±2．78）mm。B组术前椎体前缘平均高度为（14．27±2．42）mm，术后为（22．21．4±215）mm：术前椎体后缘平均高度为（22．18±2．11）mm，术后为（23．48±2．35）mm：两组间的差异亦无统计学意义（P〉0．05）。A组平均手术时问为（984-20）min，B组平均手术时间为（454±13）min，B组明显缩短（P〈0．05）。A组平均住院费用为（2．814±1．80）万元，B组平均住院费用为（2．41±161）万元，B组明显减少（P〈0．05）。结论局麻下侧卧位单侧注射与全麻下俯卧位双侧注射临床疗效基本相同，但手术时间、住院费用明显减少，值得推广应用。

Objective TO compare two surgical modalities of percutaneous kyphoplasty （PKP） in treatment of osteoporotic thoracolumbar vertebral compression fractures. Methods Fifty six patients with osteoporotic thoracolumbar vertebral compres- sion fracture were treated with vertebral expansion by vertebral body balloon-type expander and filling with bone cement. Twenty one patients （group A） received bilateral vertebral pedicle injection under general anesthesia with prone position and 35 patients （group B） received unilateral injection with lateral position under local anesthesia, The pain visual analog scale （VAS）, changes in vertebral height before and after surgery, operative time and hospital costs were compared between two groups. Results Allpatients were successfully operated, no serious complications. The VAS score of group A decreased from 8.63 ± 0.91 before operative to 1.71 ± 1.35 after operation, that of group B from 8.67 ± 0.93 to 1.69 ± 1.33（P 〉0,05）. The average preoperative an- terior vertebral height of group A was （13.30 ± 2.34）mm and that of postoperative was （23.32 ± 2.40）mm; the average preop- erative height of the posterior edge was （22.13 ± 2.11）mm and the postoperative one was 24.35mm, The average preoperative anterior vertebral height of group B was （14.27 ± 2.42）mm and the postoperative one was （22.21 ± 2,15）mm; the preoperative average height of posterior margin was （22.18±2.11）mm and the postoperative one was（23.48 ± 2.35）mm（P 〉0.05）. The meanoperative time of group A was （98 ± 20）min and that of group B was （45 ± 13）min（P〈0.05）. The average hospitalization cost of group A was （28.1 ± 18.0） thousand yuan and that of group B was （24.1 ± 16.1） thousand yuan（P〈0.05）. Conclusion Percu- taneous kyphoplasty with unilateral injection under local anesthesia on lateral position has the same clinical efficacy as that with bilateral injection under general anesthesia on prone position, but the operative time and hospital costs can be reduced when the former modality is used in treatment of osteoporotic thoracolumbar vertebral compression fractures.