经皮穿刺椎体成形术和球囊扩张椎体后凸成形术的临床应用比较

Comparison of clinical application of percutaneous vertebroplasty and kyphoplasty

目的比较经皮穿刺椎体成形术 （percutaneous vertebroplasty, PVP） 和球囊扩张椎体后凸成形术（percutaneous kyphoplasty, PKP）的手术效果、椎体高度恢复、后凸角度纠正和并发症的情况。方法回顾性分析2013年8月-2016年5月就诊于北京市垂杨柳医院骨科接受PVP或者PKP手术的109例患者，包括骨质疏松性压缩骨折、创伤性骨折和溶骨性椎体破坏病灶骨折（转移癌、血管瘤和多发骨髓瘤）。记录并比较患者临床特征、VAS疼痛评分、椎体压缩百分比、后凸角度、术后并发症、骨水泥注入量、手术时间和住院时间。结果109例患者接受了118次手术治疗，治疗了130个椎体。58个椎体PKP，72个椎体PVP。PKP术后椎体高度恢复（14．3±4．7）％．而PVP为（2．4±1．9）％（P〈0．05）。PKP平均后凸角度纠正是（7．5±3．I）°，PVP是（1．7±0．9）°（P〈0．05）。6例PVP患者出现骨水泥渗漏。5例患者发生相邻椎体骨折。1例PVP患者术后出现肺栓塞，临床死亡。结论PVP和PKP对于椎体压缩骨折（vertebral compression fractures, V CFs）都是安全有效的微创手术，PKP能够更好的恢复椎体高度，纠正后凸角度，但是要时刻警惕并发症的发生。

Objective To evaluate the outcomes of the patients who underwent percutaneous vertebroplasty（PVP） or percutaneous kyphoplasty （PKP） regarding pain relief assessment, correction of vertebral body height, kyphosis angle and complications. Methods A retrospective analysis was conducted on a total of 109 cases treated with PVP or PKP who were admitted at the hospital in between August, 2013 and May, 2016. Patients with osteoporotic compression fractures, traumatic compressions, and osteolytic vertebral lesions, including metastases, hemangiomas, and multiple myeloma, were included in this study. Preoperative and postoperative VAS pain scores; cementvolume; duration of operation; percentages of vertebral compression and kyphotic angles were measured. Demographic characteristics; postoperative complications and length of stay were recorded. Results 109 patients were treated by 118 procedures. In total, 130 levels were treated, 58 levels by PKP and 72 by PVP.Mean vertebral body height restoration was 14.3±4.7% in PKP group and 2.4±1.9% in PVP group （P 〈 0.05）.Mean kyphosis angle correction was 7.5±3.1 in PKP group and 1.7±0.9 in PVP group （P 〈 0.05）. Six patients treated with PVP had non-symptomatic cement leakage. Five patients bad adjacent level compression fractures. One patient treated with PVP was dead of pulmonary embolism.Conclusions PVP and PKP are both effective and safe minimally invasive procedures for Vertebral Compression Fractures （VCFs.）. PKP has significantly better restoration in vertebral body height and correction in kyphosis angle. However, it is important to pay attention to the occurrence of complications.