单侧弯角与直行人路椎体成形治疗骨质疏松性椎体压缩骨折疗效的对照研究

Comparison between curved and unipedicular approach vertebroplasty for treatment of osteoporoticvertebral compression fractures

目的比较单侧弯角椎体成形术（CVP）与单侧直行人路椎体成形术（UVP）治疗骨质疏松性椎体压缩骨折（OVCF）的疗效。方法采用回顾性病例对照研究分析2013年7月-2016年12月收治的77例OVCF患者临床资料，其中男12例，女65例；年龄55～86岁，平均70．8岁。损伤节段：T1-10 6椎，T11～L273椎，L3-5 12椎。根据手术方法分为CVP组（36例，44椎）和UVP组（41例，47椎）。记录两组神经血管损伤等术中术后并发症情况；比较两组手术时间、术中透视次数、伤椎骨水泥灌注量、骨水泥渗漏率、骨水泥分布不佳、椎体再骨折发生率、术前、术后1d、3个月、6个月视觉模拟评分（VAS）和Oswestry功能障碍指数（ODI）。结果两组患者均获随访6—49个月，平均25．9个月。两组均未出现穿刺相关的严重并发症。手术时间、术中透视次数、骨水泥渗漏率两组差异无统计学意义（P〉0．05），但CVP组伤椎骨水泥灌注量[（5．0±1．4）ml：（4．3±1．6）m1]、骨水泥分布不佳（0例：10例）、椎体再骨折发生率（0：10％）明显优于UVP组（P〈0．05或0．01）。两组间术前、术后各时相点VAS与ODI比较，差异均无统计学意义（P〉0．05）。两组组内术前与术后各时相点VAS、ODI比较，差异均有统计学意义（P〈0．01）。结论对于OVCF，CVP与UVP均能有效缓解疼痛和改善功能，但CVP的椎体内骨水泥分布效果更好，再骨折发生率更低。

Objective To evaluate the safety and effectiveness of a curved vertebroplasty （CVP） compared with traditional unipedicular approach vertebroplasty （ UVP ） in treating osteoporotic vertebral compression fractures （OVCF）. Methods This was a retrospective ease control study on the clinical data of 77 OVCF patients （ 12 males,65 females ; aged 55-86 years, mean 70.8 years） admitted between July 2013 and December 2016. There were 6 injured vertebrae at T1 10, 73 at T11 L2, and 12 at L3 5. The patients were divided into CVP group （36 patients, 44 vertebrae） and UVP group （41 patients, 47 vertebrae） with no significant difference in baseline clinical variables. Intraoperative and postoperative complications including neurovascular injury were recorded. Operation duration, fluoroscopy frequency, volume of cement per level, cement leakage rate per level treated, cement distribution, and refracture rate were compared between the two groups. Preoperative and postoperative visual analog scale （VAS） and Oswestry disability index （ODI） were compared both within the group and between the groups. Results No severe complications related to puncture were observed. No significant difference wasobserved for operation duration, fluoroscopy frequency, and cement leakage rate per level treated between the two groups （ P 〉 0.05 ）. Compared with UVP group, CVP group had larger volume of cement per level [ （5.0 ± 1.4） ml vs. （4.3± 1.6） ml ] , more uniform cement distribution （ none vs. 10 cases） , and lower refracture rate（ 0 vs. 10% ） （ P 〈 0.05 ）. The two groups were followed up for 6-49 months （ mean, 25.9 months）. Significant improvements on the VAS and ODI were noted within each group （P 〈0.01 ）, but there was no significant difference between the two groups （P 〉 0.05 ）. Conclusions Both CVP and UVP are safe and effective treatments for OVCF. Compared with UVP, CVP entails more uniform cement distribution and lower refracture rate.