单侧与双侧穿刺PKP术治疗骨质疏松性椎体压缩性骨折的疗效比较

Unilateral versus bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures

目的观察比较单侧与双侧穿刺经皮椎体后凸成形术（PKP）治疗骨质疏松性椎体压缩性骨折（OVCF）的临床疗效。方法回顾性分析自2010年3月—2012年7月在上虞市人民医院骨科住院治疗的72例胸腰椎OVCF患者,男性30例,女性42例,年龄65～91岁,病程1～38 d,共103椎体,其中单侧组35例52椎体,采用单侧穿刺PKP术;双侧组37例51椎,采用双侧穿刺PKP术;所有患者均随访至少1年,观察比较2组患者的手术时间和骨水泥注射量,并且观察2组患者在术前、术后和术后1年的疼痛视觉模拟评分（VAS）、椎体前缘高度情况进行比较统计分析。结果获得至少1年完整随访的患者共有68例,其中单侧组34例50椎,随访平均（16.2±2.9）月,随访率为97.14%（34/35）;双侧组34例47椎,随访平均（17.1±3.7）月,随访率为91.89%（34/37）,2组获得完整随访的患者的一般资料和随访率比较差异均无统计学意义（P〉0.05）,具有可比性;单侧组的手术时间为（30.7±4.8）min,骨水泥用量为（3.0±0.5）ml,均明显低于双侧组,差异比较均具有统计学意义（P〈0.05）;2组患者在术后和术后1年的VAS评分分别为（2.1±0.2）、（2.7±0.3）分和（2.2±0.3）、（2.6±0.5）分,椎体前缘高度分别为（24.1±3.2）、（23.7±2.3）分和（23.6±3.6）、（23.2±1.7）分,与术前比较均具有统计学意义（P〈0.05）,但是在术前、术后和术后1年单侧组与双侧组的VAS评分和椎体前缘高度相互之间比较差异没有统计学意义（P〉0.05）。结论单侧与双侧穿刺PKP术治疗OVCF具有相似的疗效;但单侧穿刺PKP术具有创伤小、手术时间短、骨水泥用量少,放射暴露少、风险小等优点。

Objective To compare the clinical efficacy of unilateral and bilateral balloon pereutaneous kyphoplasty（PKP） in the treatment of osteoporotie vertebral compression fractures （OVCF）. Methods The clinical data of 72 cases （ 30 males and 42 females, age 65 - 91 years） of thoracolumbar OVCF with a course of 1 to 38 days in our hospital from March 2010 -July 2012 were retrospectively analyzed. The unilateral approach of PKP was performed in the 35 patients （52 centrums） of the unilateral group, while the bilateral approach of PKP was performed in the 37 patients （51 centrums） of the bilateral group. All patients were followed up for at least 1 year. The operation time and the amount of bone cement injecting were compared between the two groups ;the pain visual analog scale（VAS） and vertebral height in preoperative,postoperative and 1 year after surgery were analyzed by statistically methods. Results 68 patients were followed-up for at least 1 year,including 34 cases（50 centrums） in the unilateral group with a mean time of（ 16.2 ±2.9） months and rate of 97.14% （34/35） ,and 34 cases（47 centrums） in the bilateral group with a mean time of（ 17.1 ±3.7） months and rate of 91.89% （34/37）. There was no statistical difference in the general materials and follow-up rate between the two groups （ P 〉 O. 05 ）. The operation time（30.7 ± 4.8） min and the amount of bone cement injecting（ 3.0 ±_ 0.5 ） ml in the unilater- al group was obviously lower than those in the bilateral group（P 〈0.05 ）. The VAS scores immediately and one year after the operation in the unilateral group were （2.1 ± 0.2） and （2.7 ± 0.3 ）, in the bilateral group were （2.2 ± 0.3 ） and （ 2.6 ± 0.5 ） ; the vertebral height immediately and one year after the operation in the unilateral group were （ 24.1 ± 3.2） mm and （23.7 ± 2.3） mm,in the bilateral group were （23.6± 3.6） mm and （23.2 ± 1.7） ram. The difference in VAS scores and vertebral height before and after the operation（ immediately or one year later） was significant in both groups （ P 〈 0.05 ）, but there was no difference between the two groups （ P 〉 0.05 ）. Conclusion Both unilateral and bilateral PKP have clear efficacy in the treatment of OVCF, the unilateral PKP is with the advantages of small wounds, shorter oper- ation time, small amount of bone cement, small radiation, low risk and so on.