高黏度骨水泥单侧与双侧经皮椎体成形术治疗骨质疏松性椎体压缩性骨折的临床疗效对比研究

Comparative study of unilateral percutaneous vertebroplasty and bilateral percutaneous vertebroplasty for osteoporotic vertebral compression fractures with high viscosity bone cement

目的比较高黏度骨水泥单侧与双侧经皮椎体成形术治疗骨质疏松性椎体压缩性骨折的临床疗效。方法选取2014年8月至2015年10月本院收治的96例确诊为骨质疏松性连续或间断椎体压缩性骨折患者为研究对象,按穿刺入路方式不同将其分为单侧组和双侧组,每组各48例。单侧组患者采用单侧经椎弓根入路经皮椎体成形术治疗,双侧组患者采用双侧经椎弓根入路经皮椎体成形术治疗。比较两组患者手术情况(手术时间、骨水泥注入量及C型臂X线机透视次数),术前、术后24小时及术后1、3、12个月视觉模拟评分法(visual analogue scale,VAS)评分,术前、术后1个月及术后12个月Oswestry功能障碍指数(Oswestry disability index,ODI)和Cobb角变化情况以及骨水泥渗漏发生情况。结果单侧组患者手术时间显著短于双侧组(P<0.05),C型臂X线机透视次数和骨水泥注入量均显著少于双侧组(P<0.05)。术后24小时及术后1、3、12个月,两组患者VAS评分均低于术前(P<0.05),但上述指标组间比较均无显著差异(P>0.05)。术后1个月和12个月,两组患者ODI和Cobb角均小于术前(P<0.05),但上述指标组间比较均无显著差异(P>0.05)。单侧组患者骨水泥渗漏率显著低于双侧组(P<0.05)。结论高黏度骨水泥单侧经皮椎体成形术治疗骨质疏松性椎体压缩性骨折较双侧经皮椎体成形术具有手术时间短、透视次数少、骨水泥渗漏率低等优点。

Objective To compare the clinical effects of the unilateral percutaneous vertebroplsasty with high viscosity bone cement and the bilateral percutaneous vertebroplsasty in the treatment of osteoporotic vertebral compression fractures.Method96patients diagnosed as osteoporotic continuous or intermittent vertebral compression fractures in our hospital from August2014to October2015were prospectively collected as study objects,and they were divided into unilateral group and bilateral group according to the different puncture approach(each group48cases).Patients in unilateral group received unilateral percutaneous vertebroplasty,while patients in bilateral group received bilateral percutaneous vertebroplasty.The general conditions,including operation time,amount of bone cement injection and frequency of C-arm imaging,visual analogue scale(VAS)before and24hours,1month,3months and12months after operation,Oswestry disability index(ODI)changes of Cobb's angle before and1month,12months after operations and prevalence of bone cement leakage in the two groups were compared.Result The operation time of unilateral group was significantly shorter than that of bilateral group(P<0.05).The frequency of C-arm imaging and the amount of bone cement injection in unilateral group were less than those in bilateral group(P<0.05);24hours,1month,3months and12months after operation,the VAS scores of both groups were lower than those before operation(P<0.05),but there were no significant differences in above indexes between the two groups(P>0.05).1month and12months after operation,ODI and Cobb's angles of both groups were lower than those before operation(P<0.05),but there were no significant differences in above indexes between the two groups(P>0.05).The bone cement leakage rate in unilateral group was lower than that in bilateral group(P<0.05).Conclusion There are advantages of application of the unilateral percutaneous vertebroplsasty with high viscosity bone cement in the treatment of osteoporotic vertebral compression fractures,such as shorter operation time,fewer perspective times and lower leakage rate.