单侧与双侧穿刺经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折的对比研究

A comparison study of clinical effects between unilateral and bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures

目的对比单、双侧穿刺经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCFs),探讨单、双侧穿刺PKP治疗对术后疗效是否存在差异。方法选择2013年1月至2014年6月PKP治疗的OVCFs患者共153例。其中单侧穿刺组117例,双侧穿刺组36例。统计两组手术时间、骨水泥注入量以及术前、术后的椎体前缘高度和视觉模拟评分(visual analog scale,VAS),分析两组间各项指标的差异是否具有统计学意义。结果 153例均获得完整资料。单侧穿刺组术前和术后椎体前缘高度分别为(20.5±5.2)mm和(28.7±3.7)mm,VAS评分分别为(8.0±2.8)分和(2.0±1.2)分;双侧穿刺组术前和术后椎体前缘高度分别为(20.3±3.8)mm和(22.9±3.7)mm,VAS评分分别为(8.3±1.8)分和(2.2±1.9)分,两组椎体前缘高度与VAS评分术后与术前比较,差异有统计学意义(P<0.05);单侧穿刺组与双侧穿刺组椎体前缘高度恢复、手术时间及术后症状改善差异无统计学意义(P>0.05);双侧穿刺组骨水泥注入量(4.5±0.8)ml多于单侧穿刺组的(4.2±0.5)ml,差异有统计学意义(P<0.05)。单侧穿刺组骨水泥单侧充盈与双侧充盈对于椎体前缘高度恢复程度差异无统计学意义(P>0.05),两组对术后症状改善差异亦无统计学意义(P>0.05)。结论单侧与双侧穿刺PKP治疗骨质疏松性椎体压缩性骨折均能获得良好临床疗效。两种方式对椎体前缘高度恢复、术后症状改善及手术时间方面无明显差异。双侧穿刺方法骨水泥注入量较单侧穿刺多。骨水泥在骨折椎体内单侧充盈与双侧充盈对术后临床疗效及椎体高度恢复无显著影响。

Objective To compare the clinical effects between unilateral and bilateral percutaneous kyphoplasty（ PKP） for osteoporotic vertebral compression fractures（ OVCFs）. Method A total of 153 cases of OVCFs underwent PKP from January 2013 to June 2014. There were 117 cases of unipedicular approach and 36 cases bipedicular approach. Operative time, and injection rate of bone cement were observed. Visual Analogue Scale（ VAS） and average vertebral body height were measured pre- and post operation. Results All 153 cases had complete follow-up data. The average vertebral height of the unilateral group were（ 20.5 ± 5.2） mm,（ 28.7 ± 3.7） mm and VAS score were（ 8.0 ± 2.8） points,（ 2.0 ± 1.2） points pre- / post operation separately. The average vertebral height of the bipedicular group were（ 20.3 ± 3.8） mm,（ 22.9 ± 3.7） mm and VAS score were（ 8.3 ± 1.8） points,（ 2.2 ± 1.9） points pre- / post operation separately. The vertebral height and VAS score were statistically improved in both groups after the operation（ P〈0.05）. However, there were no statistical differences of vertebral height, operation time and complications improvement in two groups（ P〉0.05）. The volume of bone cement injected in the unipedicular approach group was much less than that of bilateral group [（ 4.2 ± 0.5） ml vs.（ 4.5 ± 0.8） ml ] with statistical differences（ P〉0.05）. Bone cement unilateral filling or bilateral filling in the unilateral group had no statistical differences with vertebral height（ P〉0.05）. No significant differences existed in complication improvement in 2 groups（ P〉0.05）. Conclusions Both unilateral and bilateral PKP are effective in the treatment of osteoporotic thoracolumbar compression fractures. No statistical differences exist in vertebral height, operation time and complications improvement in two groups. The volume of injected bone cement is more in the bilateral group. Bone cement unilateral filling or bilateral filling has no statistical differences with vertebral height recovery and clinical effects.