单、双侧椎弓根入路经皮椎体后凸成形术临床回顾的比较研究

Retrospective Comparative Study on the Clinical Effect of Unipedicular Percutanous Kyphoplasty and Bipedicular Percutanous Kyphoplasty

目的比较经单、双侧椎弓根入路灌注骨水泥经皮椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩骨折(OVCF),回顾性评价两种手术入路的临床效果。方法选取2008年10月至2011年12月首都医科大学良乡教学医院骨科收治的OVCF患者112例作为研究对象,所有患者均接受PKP治疗,其中经单侧椎弓根入路组65例68个椎体,经双侧椎弓根入路组47例59个椎体。比较两组患者的术前及术后1 d视觉模拟评分(VAS),伤椎高度,后凸Cobb's角、手术时间、骨水泥注入量、伤椎高度丢失,骨水泥渗漏及随访期间邻近椎体骨折情况。结果两组患者在手术时间(t=-11.905,P=0.002)、骨水泥注入量(t=-2.810,P=0.007)、骨水泥渗漏(χ2=5.477,P=0.019)及相邻椎体骨折(χ2=4.394,P=0.036)等方面比较差异有统计学意义;单侧椎弓根入路组患者术后即刻椎体高度增加显著低于双侧椎弓根入路组(t=-2.978,P=0.004),术后12个月椎体高度丢失显著高于双侧椎弓根入路组(t=11.511,P=0.001);两组椎体压缩骨折患者的后凸Cobb's角在不同时点间、组间以及组间·不同时点间比较差异均无统计学意义(F=0.063,3.765,0.072,P>0.05);VAS在不同时点间、组间以及组间·不同时点间比较,差异均有统计学意义(F=5.783,106.558,19.101,P<0.05)。结论两种骨水泥灌注入路都能较好的恢复椎体高度,并达到理想的止痛效果,双侧椎弓根入路PKP远期效果较单侧入路好。

Objective To retrospectively analyze the clinical effect of unipedicular and bipedicular vertebroplasty percutanous kyphoplasty on treating osteoporotic vertebral compression fractures （OVCF）.Methods A total of 112 cases of OVCF patients admitted in Liangxiang Teaching Hospital from Oct.2008 to Dec.2011 were collected.All of the patients were treated with PKP,among which 65 cases （68 vertebrae） were treated with PKP from unipedicular vertebroplasty and 47 cases（59 vertebrae）were treated with PKP from bipedicular vertebroplasty.The indexes of VAS,height and Cobb angle of the injured vertebra before treatment and 1 day after treatment as well as the operation time,vertebrae height loss,amount of bone cement injection,leakage of bone cement andnew fracture status of adjacent vertebra occurred during follow-up of the two groups were compared.Result The differences of operation time（t =-11.905,P =0.002）,amount of bone cement injection（t =-2.810,P =0.007）,leakage of bone cement（x2 =5.477,P =0.019） and new fracture of adjacent vertebra（x2 =4.394,P =0.036） of the two groups were statistically significant.Immediate vertebral body height of the group treated with PKP from unipedicular vertebroplasty increased less than the group treated with PKP from bipedicular vertebroplasty（t =-2.978,P =0.004）,while the vertebral height loss after 12 months was significantly higher than the group treated with PKP from bipedicular vertebroplasty （t =11.511,P =0.001）.The Cobb＇ s angle of vertebral compression fractures of the two groups had no statistically significant difference at different time points,different groups,and different time points · groups（F =0.063,3.765,0.072,P 〉 0.05）.VAS of the two groups at different time points,different groups,different time points · groups had statistically significant difference（F =5.783,106.558,19.101,P 〈 0.05）.Conclusion Both of the PKP methods are reliable in restoring vertebral body height and pain relief,while the long-term effect of PKP from bipedicular vertebroplasty is better than PKP from unipedicular vertebroplasty.