单侧与双侧经皮椎体后凸成形术治疗老年新鲜骨质疏松性椎体骨折的临床疗效

Effectiveness of unilateral and bilateral percutaneous kyphoplasty for fresh senile osteoporotic vertebral compression fractures

目的探讨单侧与双侧经皮椎体后凸成形术(PKP)治疗老年新鲜骨质疏松性椎体压缩骨折(OVCF)的临床疗效。方法回顾性分析2009年1月至2015年10月间,承德市中心医院收治的行PKP治疗的148例老年新鲜胸腰段OVCF患者,其中单侧穿刺组76例(椎体),双侧穿刺组72例(椎体)。对比分析两组患者的手术时间、穿刺次数、放射线暴露次数、骨水泥渗漏例数、术前及术后疼痛视觉模拟评分(VAS)、椎体后凸Cobb角改善情况,评估手术疗效。结果 148例患者均成功穿刺并顺利完成手术。与双侧穿刺相比,单侧手术组患者的手术时间较短[(45.6±2.0)min vs(29.4±1.8)min];穿刺次数较少[(7.9±1.8)次vs(3.6±1.2)次];放射线暴露次数较少[(12.5±1.6)次vs(7.2±1.3)次);骨水泥渗漏率较低(13.89%vs 6.58%);差异均有统计学意义(t=18.937,t=14.219,t=12.786,t=4.051,P<0.001)。两组VAS评分术后较术前均有改善,差异均有统计学意义(单侧组:F=25.381;双侧组:F=23.720,均P<0.001),组间比较除术后1 d单侧穿刺组[(4.17±0.26)分]低于双侧穿刺组[(4.29±0.31)分]外(F=8.451,P<0.05),其余时间点差异均无统计学意义。单侧穿刺组与双侧穿刺组骨水泥注入量为(2.8±0.3)ml和(3.1±0.5)ml,差异无统计学意义。单侧与双侧穿刺组术后椎体后凸Cobb角较术前均有改善(F=12.981,F=17.660,P<0.001),各时间点组间比较差异无统计学意义。两组患者均无脊髓、神经损伤,无切口感染、出血、肺栓塞等并发症。结论单侧穿刺PKP可以显著缩短手术时间,减少穿刺风险,降低医患的放射线暴露及骨水泥渗漏率,临床效果良好。

Objective To explore the effectiveness of unilateral and bilateral percutaneous kyphoplasty in the treatment of fresh senile osteoporotic vertebral compression fractures. Methods One hundred and forty eight elderly patients with fresh thoracolumbar vertebral osteoporotic compression fractures treated in Central Hospital of Chengde from January 2009 to October 2015 were retrospectively analyzed, they were divided into the unilateral puncture group （76 vertebras） and the bilateral puncture group （72 vertebras）. Operation time, puncture times, radiation exposure, cement extravasation, preoperative and postoperative visual analogue scale （VAS） score, postoperative Cobb angle improvement were compared between two groups to assess the surgical effectiveness. Results One hundred and forty eight patients were treated successfully. The operation time of unilateral group was shorter than the bilateral group （29.4 ± 1.8 min vs 45.6±2.0 min） ; puncture times of unilateral group was less than bilateral group （3.6±1.2 times vs 7.9± 1.8 times）;same as the radiation exposure （7.2 ± 1.3 times vs 12.5 ± 1.6 times） and incidence of cement extravasation （6.58% vs 13.89% ）, all differences were statistically significant （t=18.937, t=14.219, t= 12.786, t=4.051, P〈0.001）. The VAS score of two groups were significantly improved after treatment （unilateral： F=25.381, bilateral： F=23.720, P〈0.001）, except for postoperative 1 d of unilateral group （4.17±0.26 points） was lower than bilateral group （4.29±0.31 points） （F=8.451, P〈0.001）, there were no significant differences between two groups. Volume of cement injection of two groups were （2.8±0.3） ml and （3.1±0.5） ml, no statistically significant differences were observed. The Cobb angle of each group were improved after treatment （F=12.981, F=17.660, P〈0.001）, while no statistically significant difference was observed at different time points in intragroup. There were no spinal cord or nerve damage, incision infection and other complications （bleeding, pulmonary embolism） in both groups. Conclusion Unilateral puncture PKP treat OVCFs can achieve satisfactory effectiveness, significantly shorter operation time, less puncture risk, radiation exposure and cement extravasation.