单、双侧椎弓根穿刺椎体后凸成形术后相邻椎体再骨折的临床研究

CLINICAL STUDY OF ADJACENT VERTEBRAL FRACTURES AFTER UNILATERAL OR BILATERAL PEDICLE PUNCTURE PERCUTANEOUS KYPHOPLASTY

目的探讨经皮单、双侧椎弓根穿刺椎体后凸成形术(PKP)治疗椎体压缩性骨折术后相邻椎体再骨折的可能因素。方法选取2012年1月—2013年12月骨质疏松性椎体压缩骨折患者112例(椎),为单侧注射组(64例)与双侧注射组(48例),行PKP术并记录两种穿刺方法的骨水泥注入量及术中水泥渗漏率,测量术后椎体高度恢复率,分别于术后1周、术后3个月应用DEXA检查测定相邻椎体骨密度,术后随诊12个月,对比相邻椎体骨折发生率。结果双侧椎弓根穿刺PKP术患者骨水泥注入量较单侧穿刺组多(P<0.05),双侧椎弓根穿刺PKP术患者骨水泥注入量较单侧穿刺组水泥渗漏率低(P<0.05),二组术式相比术后椎体高度恢复率无明显差异(P>0.05),双侧椎弓根穿刺PKP术后相邻椎体骨密度减少程度较低(P<0.05),且术后6个月相邻椎体再骨折发生率较单侧穿刺组患者低(P<0.05)。结论双侧椎弓根穿刺在减少骨水泥渗漏,并且减少相邻椎体再骨折方面较单侧穿刺组更具优势。

Objective To investigate the correlative factors of adjacent vertebral fractures after Unilateral or bilateral puncture percutaneous Kyphoplasty（PKP）for osteoporotic vertebral compression fractures（OVCFs）.Methods From January 2012 to December 2013,112 patients with thoracolumbar osteoporotic vertebral fracture treated by PKP were retrospectively analyzed.Among them,48 patients with OVCF were treated with Unilateral Pedicle puncture PKP,64 patients with OVCF were treated with bilateral Pedicle puncture PKP.The amount of injected bone cement per vertebra,the extravasation of cement rate and postoperative vertebral Height restoration rate were compared between two groups to find correlative factors of adjacent vertebral fractures.The bone mineral density of adjacent vertebral was measured by dualenergy X-ray absorptiometry（DEXA）in 1 week and 3 months postoperatively.All patients were followed up 12 months,the rate of adjacent vertebral fracture occurred were compared between2 groups.Results The amount of injected bone cement per vertebra was much lower in Unilateral Pedicle puncture group than in bilateral Pedicle puncture.The incidence of cement leakage was much higher in Unilateral Pedicle puncture group than bilateral Pedicle puncture group（P〈0.05）.The bone mineral density changes,postoperative vertebral height compression rate of bilateral Pedicle puncture group was much lower compared with Unilateral Pedicle puncture group（P〈0.05）.There was no significant difference in postoperative vertebral Height restoration rate between two groups（P〉0.05）.Conclusion Bilateral pedicle puncture PKP in reducing the leakage of bone cement,and to reduce the adjacent vertebral fracture than unilateral puncture PKP has more superiority.