不同入路经皮椎体后凸成形术治疗骨质疏松性椎体压缩性骨折63例

Efficacy Comparison between Different Approaches of Percutaneous Kyphoplasty in Treatment of 63 Patients with Osteoporotic Vertebral Compression Fractures

目的观察单侧与双侧椎弓根入路经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松性椎体压缩性骨折(osteoporotic vertebral compression fractures,OVCFs)的临床疗效。方法选择2010年1月—2012年1月在我院行PKP治疗的OVCFs 63例78个椎体,按手术入路方式分成A组37例和B组26例。A组采用单侧椎弓根入路,B组采用双侧椎弓根入路。观察两组手术时间、术中出血量、透视次数、骨水泥灌注量,视觉模拟评分(visual analogue scale,VAS)和改良Oswsetry功能障碍指数(oswsetry disability indexes,ODI),LAK角和椎体相对高度的恢复情况。结果 A组手术时间、术中出血量、透视次数、骨水泥灌注量均少于B组(P<0.01)。两组术后VAS、ODI、LAK角、椎体相对高度均较术前明显改善(P<0.01)。两组邻近椎体骨折及骨水泥渗漏发生率比较差异无统计学意义(P>0.05)。结论单侧与双侧椎弓根入路PKP治疗OVCFs均可获得良好的临床疗效,但单侧椎弓根入路具有手术时间短、术中出血量少、透视次数少、骨水泥灌注量少的优点。

Objective To observe the clinical efficacy of the unilateral versus bilateral percutaneous kyphoplasty （PKP） through pedicle of vertebral arch in treatment of osteoporotic vertebral compression fractures （OVCFs）. Methods A total of 63 patients （78 vertebrae） with OVCFs during January 2010 and January 2012 were randomly divided into group A （n = 37） and group B （n = 26）. Group A was treated with unilateral approach through pedicle of vertebral arch, and group B was treated with bilateral approaches through pedicle of vertebral arch. The operation time, intraoperative bleeding volume, X-ray exposure frequency, the priming volume of bone cement, visual analogue scale, reformative oswsetry disability indexes （ODI） , recoveries of the local kyphotic angle and vertebrae relative height were observed. Results The operation time, intraoperative bleeding volume, X-ray exposure frequency and the priming volume of bone cement in group A were much less than those of group B （P 〈 0. 01）. The V AS, ODI, the local kyphotic angle and fracture vertebrae height after operation in the two groups were significantly improved compared with those before operation （P 〈 0.01）. There were no significant differences in incidence rates of adjacent fracture of vertebra body and bone cement leakage in the two groups （P 〉 0. 05）. Conclusion Both unilateral and bilateral PKP through pedicle of vertebral arch in treatment of OVCFs can achieve effective outcomes, but the unilateral PKP through pedicle of vertebral arch can shorten the operation time, reduce intraoperative bleeding volume and X-ray exposure time and decrease the priming volume of bone cement.