单、双侧入路经皮椎体成形术治疗骨质疏松性压缩骨折的疗效比较

Comparing study of unilateral and lateral PVP operation treating osteoporosis compression fracture

目的比较单侧与双侧经皮椎体成形术治疗骨质疏松所致胸腰椎压缩性骨折的临床疗效。方法前瞻性随机对照研究本院2011年5月~2014年5月骨质疏松所致胸腰压缩性骨折患者,其中采用双侧椎弓根入路经皮穿刺椎体成形术组68例,单侧椎弓根入路经皮椎体成形术组85例。观察术后疼痛缓解、椎体高度变化、骨水泥渗漏及再骨折发生情况,比较两组患者手术时间、X线照射次数及术后VAS（视觉模拟疼痛）评分。结果单侧组手术时间（20±5.34）min少于双侧组（40±6.53）min（P〈0.05）;单侧组术中X线曝光（8±4.5）次少于双侧组（17±3.8）次（P〈0.001）,两组骨水泥渗漏率、术后椎体高度恢复及术后1天VAS评分比较无明显差异（P〉0.05）。结论单侧经皮椎体成形术治疗骨质疏松性压缩性骨折具有手术时间短,患者在术中进行X线照射次数少等优点,可作为治疗骨质疏松性压缩性骨折的首选方法,对于在术中发现弥散不均匀的,可考虑行双侧注射。

Objective To compare the clinical curative effect of treating thoracolumbar spine compression fracture due to osteoporosis by unilateral percutaneous vertebroplasty and lateral percutaneous vertebroplasty. Methods A prospective randomized study was conducted on patients suffering from thoracolumbar spine com- pression fracture due to osteoporosis that had been hospitalized in our hospital from May 2011 to May 2014. Patients were assigned to two groups and received unilateral （85 cases） or bilateral （68 cases） PVP treatment under local anesthesia. Under the guideline of C-arm perspective, the symptomatic vertebrae was punc- tured through unilateral or lateral pedicle of vertebral arch and bone cement （ polymethyl methacrylatc） was injected. The occurrence conditions of postoperative pain relief, centrum altitude variation, bone cement leakage and re-fracture were observed. The operative length, X-ray irradiation times and postoperative VAS （ visual simulation pain ） score of two groups were compared. Results The operation time of unilateral group was （20±5.34） min, evidently shorter than that of lateral group （40±6.53） min, and the difference had significance （P〈0.05） ; the X-ray exposure of unilateral group was （ 8±4.5 ） times, evidently less than that of lateral group（17±3.8） times, and the difference had significance （P〈0. 001）; the cement leakage rate , the postoperative vertebral height recovery and the VAS score at one day after operation of two groups had no evident difference （P〉0.05）. Conclusion Unilateral percutaneous vertebroplasty treating osteoporosis compression fracture has the advantages of short operation time, less X-ray irradiation times during the operation, so it can be the first choice for treating osteoporosis compression fracture, and in case of the une- ven dispersion, bilateral injection during surgery should be considered.