单双侧入路PKP治疗骨质疏松性椎体压缩骨折的临床研究

Clinical Comparison of Unilateral and Bilateral Percutaneous Kyphoplasty for Treating Osteoporotic Vertebral Compression Fractures

目的:比较双侧与单侧入路椎体后凸成形术治疗骨质疏松性椎体压缩骨折疗效的差异。方法:2004年1月-2007年12月,对77例诊断为骨质疏松性椎体压缩骨折的病人随机分为经椎弓根单侧入路组与双侧入路组。单侧入路组37例,双侧入路组40例,术后所有患者得到随访,在术后第1、6、12、24、36个月进行评估,比较两组病人临床疗效,包括手术前后的视觉模拟疼痛评分VAS,Oswestry功能障碍指数,病椎前缘、中部的高度和脊柱的Cobbs角以及两者术后的并发症的差异。结果:所有患者术后腰背部疼痛均明显缓解,均未发生神经损伤等并发症,两组患者腰背痛缓解程度,伤椎前缘和中部高度恢复及脊柱后凸畸形矫正度2年内比较差异无统计学意义(P>0.05),但第3年比较差异有统计学意义(P<0.05);两组透视时间和手术所用时间比较差异有统计学意义(P<0.05),但两组术中术者X线暴露时间差异无统计学意义(P>0.05)。结论:单入路较双入路并不能明显减少医务人员的放射暴露,在随访中近期的临床疗效与双侧入路相似,但中期疗效双侧入路好于单侧入路。

Objective：A randomized clinical study was conducted to compare the outcome between unilateral and bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures.Methods：From 2004 to 2007,77 cases of osteoporotic vertebral compression fractures,divided into unipedicular approach group（n=37） and bipedicular approach group（n=40）,were treated with percutaneous kyphoplasty.All cases were followed up and got a clinical assessment at1,3,6,12and 24 months after surgery.The results of VAS,ODI,Cobb angle,vertebral body and disc height were separately compared between the two groups.Results：All patients tolerated the procedure well with immediate relief of back pain after surgery.Complications such as neural damage were not observed in the study.There was no significant differences between the two groups in the kyphosis correction and pain relief within 2 years（P0.05）,but was significant differences（P0.05） in the first 3 years.The mean operative time and fluoroscopy time in the unilateral approach group were significantly less than those in the bilateral approach group（P0.05）.In terms of the X-ray exposure time during operation,there was no significant difference between the two groups（P0.05）.Conclusions：The fluoroscopy time of unipedicular approach was no less then that of bipedicular approach.Short-term follow-up study showed that,the clinical effect of unipedicular approach was similar to that of bipedicular approach,but the medium-term efficacy of bilateral approach is better than that of unilateral approach.