单侧入路经皮椎体成形术治疗伴裂隙样变的骨质疏松性椎体压缩骨折

PERCUTANEOUS VERTEBROPLASTY TO TREAT OSTEOPOROTIC VERTEBRAL COMPRESSION FRACTURES COMBINED WITH INTRAVERTEBRAL CLEFTS BY UNILATERAL APPROACH

目的比较研究单侧入路经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗伴或不伴椎体内裂隙样变的骨质疏松性椎体压缩骨折的疗效,分析椎体内裂隙样变对疗效的影响。方法回顾性分析2008年1月-2011年3月符合选择标准的65例骨质疏松性椎体压缩骨折患者,根据是否伴椎体内裂隙样变,分为裂隙样变组(A组,25例)和非裂隙样变组(B组,40例)。两组性别、年龄、致伤原因、损伤节段、骨折程度、伤后至手术时间等一般资料比较差异均无统计学意义(P>0.05),具有可比性。均采用单侧入路PVP治疗。记录两组手术时间、注入骨水泥量、起床活动时间、并发症、相邻椎体再骨折等。术前、术后1周及48周通过站立侧位X线片测量伤椎前中柱椎体高度和伤椎后凸Cobb角的变化;术前,术后1、4、48周分别采用疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评价疼痛缓解及功能改善情况。结果两组手术时间、起床活动时间比较差异均无统计学意义(P>0.05),注入骨水泥量B组少于A组(t=1.833,P=0.034)。术中发生骨水泥渗漏6例(A组4例、B组2例),其中A组渗漏至静脉丛1例,椎体周围2例,椎间盘内1例;B组渗漏至静脉丛2例。无症状性肺动脉栓塞发生,术中、术后生命体征均平稳。两组均获随访,随访时间12～30个月,平均18.5个月。随访期间无相邻及远位椎体骨折,无受伤椎体再骨折。两组术后各时间点VAS评分、ODI、椎体前中柱高度及伤椎后凸Cobb角均较术前显著改善,差异有统计学意义(P<0.05);术前及术后各时间点两组间比较差异均无统计学意义(P>0.05)。结论单侧入路PVP是治疗伴椎体内裂隙样变的骨质疏松性椎体压缩骨折的有效方法,椎体内裂隙样变对PVP的止痛疗效、功能改善无明显影响。

Objective To evaluate the effectiveness of percutaneous vertebroplasty（PVP） in the treatment of osteoporotic vertebral compression fractures with or without intravertebral clefts by unilateral approach and the impact of intravertebral clefts on the effectiveness.Methods The clinical data of 65 patients who met the inclusion criteria of osteoporotic vertebral compression fracture were retrospectively analyzed.According to having intravertebral clefts or not,the patients were divided into 2 groups： cleft group（group A,n=25） and non-cleft group（group B,n=40）.There was no significant difference in gender,age,cause of injury,the level of fracture vertebrae,degree of damage,and interval of injury and operation between 2 groups（P 0.05）.All patients were given PVP procedure by unilateral approach.The operation time,the injected volume of bone cement,time to ambulate,complications,and adjacent vertebral re-fracture were recorded.The height of anterior and middle column and the posterior convex Cobb angle of injured spine were measured on the lateral X-ray film in standing position at preoperation and 1,48 weeks after operation.The visual analogue scale（VAS） score and Oswestry disability index（ODI） system were used to evaluate the pain relief and improvement of daily activity function respectively at preoperation and 1,4,and 48 weeks after operation.Results There was no significant difference in the operation time and time to ambulate between 2 groups（P0.05）.The injected volume of bone cement in group B was significantly less than that in group A（t=1.833,P=0.034）.Asymptomatic cement leakage occurred in 6 patients（4 in group A and 2 in group B）,in group A including 1 case of venous leakage,2 cases of paravertebral leakage,and 1 case of intradiscal leakage;in group B including 2 cases of venous leakage.No symptomatic pulmonary embolism was observed.The vital sign was stable during operation and postoperatively.All patients were followed up 12-30 months（mean,18.5 months）.No re-fracture of the vertebrae occurred during the follow-up.The postoperative VAS score,ODI,the height of anterior and middle column,and the posterior convex Cobb angle of injured spine were improved significantly when compared with the preoperative ones in 2 groups（P 0.05）,but no significant difference was found between 2 groups at pre-and post-operation（P 0.05）.Conclusion PVP by unilateral approach is safty and efficacy in the treatment of osteoporosis vertebral compression fracture combined with intravertebral clefts.Intravertebral clefts have no significant impact on the effectiveness in the pain relief and function improvement.