经皮椎体后凸成形术以椎弓根入路治疗老年骨质疏松性椎体压缩性骨折

Application of percutaneous kyphopoplasty using unilateral or bilateral pedicle approach in the treatment of senile osteoporotic vertebral compression fractures

目的比较经皮椎体后凸成形术(PKP)单侧与双侧椎弓根入路治疗北温带大陆性气候地区老年骨质疏松性椎体压缩性骨折(OVCFs)的近期疗效。方法回顾性分析2010年1月至2012年1月收治的68例新疆地区OVCFs患者。根据患者治疗方式的不同分为PKP单侧椎弓根入路组(40例,50节椎体,A组)和PKP双侧椎弓根入路组(28例,28节椎体,B组)。患者均经核磁共振证实且疼痛持续时间小于3个月。比较两组治疗前后视觉模拟评分(VAS)、功能障碍评分(ODI)、伤椎后凸角度(LKA)、椎体前缘中柱相对高度;比较两组手术时间、透视次数、骨水泥量、住院时间、骨水泥渗漏及随访1年期间邻近椎体再骨折的情况。结果所有患者均完成至少1年随访,两组术前骨密度、VAS评分、ODI评分、椎体前缘中柱相对高度比较,差异均无统计学意义(P>0.05);A组与B组手术时间、透视次数、骨水泥量、术后椎体前缘中柱相对高度比较,差异均有统计学意义(P<0.01),但住院时间、术后VAS评分、ODI评分、骨水泥渗漏发生率两组比较差异无统计学意义(P>0.05);A、B两组患者术前VSA评分、ODI评分、椎体前缘中柱相对高度与术后比较,差异均有统计学意义(P<0.01);A组未发生邻近椎体再骨折,而B组发生2例邻近椎体再骨折。结论 PKP不同入路治疗北温带大陆性气候地区老年性OVCFs,术后VSA评分、ODI评分及LKA角较术前均有改善。单侧入路改善术后椎体前缘中柱相对高度较好,而双侧入路存在增加手术时间、透视次数、骨水泥量的缺点,随访期间有发生邻近椎体再骨折现象。

Objective To compare the recent curative effects of percutaneous kyphopoplasty （PKP） using uni-lateral or bilateral pedicle approach for the treatment of senile ostcoporotic vertebral compression fractures （OVCFs） in north temperate continental climate region .Methods A total of 68 OVCFs patients of Xinjiang region ,treated from Jan .2010 to Jan .2012 ,were enrolled ,and divided into PKP using unilateral pedicle approach group （group A ,40 cases ,50 vertebral bodies） and PKP using bilateral pedicle approach group（group B ,28 cases ,28 vertebral bodies） . All patients were confirmed by MRI examination ,and with pain lasting less than 3 months .Preoperative and postop-erative visual analogue scale（VAS） ,Oswsetry disability indexes（ODI） ,local Kyphosis angle（LKA） ,relative column height of fanterior edge were compared ,and operation time ,number of perspective examination ,bone cement quanti-ty ,hospitalized duration ,bone cement leakage and relapse of adjacent vertebral fracture during the follow-up of 1 year were also compared between the two groups .Results All patients received follow-up of at least 1 year .Preoperative bone density ,VAS score ,ODI score and relative column height of fanterior edge were without significant difference between the two groups（P〉 0 .05） .Operation time ,number of perspective examination ,bone cement quantity and postoperative relative column height of fanterior edge were with statistical difference between the two groups （P〈0 .01） ,but hospitalized duration ,postoperative VAS score ,ODI score and bone cement leakage rate were without sig-nificant difference between the two groups（P〉0 .05） .In group A and B ,preoperative and postoperative VSA score , ODI score and relative column height of fanterior edge were with significant difference （P〈0 .01） .There was no pa-tient in group A with relapsing of adjacent vertebral fractures ,but two cases in group B were with relapsing of adja-cent vertebral fractures .Conclusion PKP using different approaches in the treatment of senile OVCFs patients in north temperate zone continental climate region could improve postoperative VSA score ,ODI score and LKA Angle . Unilateral pedicle approach might be superior to bilateral pedicle approach for the improvement of relative column height of fanterior edge ,and the latter might causing the increasing of operation time ,number of perspective examina-tion and bone cement quantity ,also might causing relapsing of adjacent vertebral fracture during follow-up .