液压输送式椎体成形术与扩张球囊椎体后凸成形术治疗单节段骨质疏松性脊柱骨折的疗效比较

Hydraulic delivery vertebroplasty versus balloon kyphoplasty: radiographic and morphologic outcomes in single level osteoporotic vertebral compression fracture

[目的]对比分析评估新型液压输送式椎体成形术与扩张球囊椎体后凸成形两种术式在治疗单节段骨质疏松性脊柱骨折中疗效的差异。[方法]对本院骨科一区2012年5月~2013年9月间符合条件的64例单节段骨质疏松性脊柱骨折患者术前随机分为液压输送式椎体成形（A组,34例）以及扩张球囊椎体成形（B组,30例）两组,分别进行相应的手术术式处理。术后随访1年,通过VAS评分、ODI评分评估患者手术前后症状改善、功能恢复情况;通过骨水泥渗漏与否、椎体高度恢复程度、骨水泥弥散情况等进一步分析比较两种不同椎体成形术式治疗脊柱骨折疗效及预后可能产生的差异。[结果]两组患者术后VAS评分及ODI评分均较术前明显改善,术后1年时椎体高度恢复率A、B两组分别为（27.84±2.12）%和（29.82±5.13）%。A、B两组患者均未出现骨水泥过敏、肺栓塞、椎管渗漏引起神经症状等严重并发症。无症状性骨水泥渗漏发生例数分别为7例和3例（P〈0.05）。[结论]液压输送式椎体成形术与扩张球囊式椎体后凸成形术在改善单节段骨质疏松性脊柱骨折症状及功能方面疗效相当。二者骨水泥弥散情况和椎体高度恢复率的比较差异无统计意义,提示液压输送式椎体成形术在有着更简洁的手术过程、更简短的手术时间、更经济的手术花费的同时,在手术疗效以及结构恢复等方面都有着不差于扩张球囊式椎体后凸成形术的效果,而且对术后同椎、邻椎骨折的发生可能有着更好的预后。

[ Objective ] To compare a novel modified vertebral augmentation technique -hydraulic delievery vertebroplasty （HDVP） with balloon kypboplasty（BKP） for the treatment of single level osteoporotic vertebral compression fracture in terms of pain relief, function improvement, vertebral height restoration and complications. [ Method ] From May 2012 to Setptember 2013, 64 patients suffering from single level ostooporotic vertebral compression fracture underwent HDVP（ Group A, n = 34） and BKP （ Group B, n = 30） procedures. Visual analogue scale （VAS） and Oswestry Disability Index （ODI） were used to evaluate the improvement of symptom and function. Height restoration rates and diffusion evaluation were used to analyze the vertebral recon- struction. Complication rates including cement extravasation and refracture were recorded and assessed to compare the safety and prognosis between groups. [ Result] In both groups,VAS and ODI improved significantly and remained relatively stable through- out the postoperative 6 months follow - up period. Mean high restoration rate of Group A and B were 27.84% ±2.12% and 29. 82%± 5.13% at one year postoperatively. Cement diffusion of the two group showed no statistical difference（P 〉0. 05）. There were 7 and 3 asymptomatic cement extravasations and in Group A and B, respectively, with significant difference （ P 〈 0.05 ）. Meanwhile, 1 and 2 new vertebral fractures was found in each group. [ Conclusion ] HDVP and BKP are both effective methods in not only providing pain relief functional improvement, but also supplying vertebral structure reconstruction and satisfactory ce- ment diffusion. HDVP has advantages of more compact operating procedure, shorter duration of operation,less economic cost and better prognosis of refracture of the same and adjacent vertebrae. But BKP still shows advantage in prognosis of cement leakage.