单侧经横突-椎弓根入路与双侧经椎弓根入路经皮椎体成形术治疗重度骨质疏松性椎体压缩性骨折合并脊柱侧弯的比较研究

Percutaneous vertebroplasty through unilateral transverse process-pedicle approach versus bilateral transpedicular approach for treatment of severe osteoporotic vertebral compression fractures and scoliosis: a comparative study

目的:比较单侧经横突-椎弓根入路经皮椎体成形术(percutaneous vertebroplasty,PVP)与双侧经椎弓根入路PVP治疗重度骨质疏松性椎体压缩性骨折(osteoporotic vertebral compression fractures,OVCF)合并脊柱侧弯的临床疗效和安全性。方法:将符合要求的36例重度OVCF合并脊柱侧弯患者随机分为2组,每组18例,分别采用单侧经横突-椎弓根入路PVP治疗(单侧组)和双侧经椎弓根入路PVP治疗(双侧组)。记录并比较2组患者的手术时间、X线透视次数、骨水泥灌注量、住院时间、并发症发生情况以及术后第2天椎体高度恢复率[(术后椎体高度-术前椎体高度)/术后椎体高度]和脊柱侧弯Cobb角纠正度数(术前Cobb角-术后Cobb角),并分别于术前及术后1周、3个月、12个月比较2组患者腰背部疼痛视觉模拟量表(visual analogue scale,VAS)评分及Oswestry功能障碍指数(Oswestry disability index,ODI)。结果:①一般情况。2组患者均获随访,随访时间(18. 3±6. 4)个月。2组患者术后第2天椎体高度恢复率和脊柱侧弯Cobb角纠正度数以及骨水泥灌注量、住院时间比较,差异均无统计学意义[(27. 6±5. 6)%,(28. 3±4. 9)%,t=0. 400,P=0. 700; 8. 2°±2. 8°,8. 9°±3. 1°,t=0. 710,P=0. 480;(4. 0±0. 7) m L,(4. 2±0. 8) m L,t=0. 800,P=0. 430;(9. 5±2. 1) d,(9. 6±2. 2) d,t=0. 140,P=0. 890];单侧组手术时间短于双侧组[(23. 4±4. 3) min,(32. 6±5. 6) min,t=5. 530,P=0. 000],X线透视次数少于双侧组[(5. 8±0. 8)次,(9. 7±1. 1)次,t=12. 170,P=0. 000]。②腰背部疼痛VAS评分。时间因素与分组因素不存在交互效应(F=2. 520,P=0. 270); 2组患者腰背部疼痛VAS评分比较,组间差异无统计学意义,即不存在分组效应(F=1. 420,P=0. 150);手术前后不同时间点之间腰背部疼痛VAS评分的差异有统计学意义,即存在时间效应(F=34. 620,P=0. 000); 2组患者腰背部疼痛VAS评分随时间均呈降低趋势,且2组的降低趋势完全一致[(6. 7±0. 9)分,(2. 8±1. 2)分,(2. 2±0. 7)分,(1. 6±0. 7)分,F=8. 870,P=0. 000;(6. 6±0. 8)分,(2. 8±1. 1)分,(2. 0±0. 6)分,(1. 4±0. 7)分,F=6. 320,P=0. 000]。③ODI。时间因素与分组因素不存在交互效应(F=20. 360,P=0. 380); 2组患者ODI比较,组间差异无统计学意义,即不存在分组效应(F=3. 440,P=0. 640);手术前后不同时间点之间ODI的差异有统计学意义,即存在时间效应(F=25. 480,P=0. 000); 2组患者ODI随时间均呈降低趋势,且2组的降低趋势完全一致[(68. 1±6. 1)%,(32. 6±5. 9)%,(22. 2±3. 8)%,(18. 2±2. 6)%,F=22. 740,P=0. 000;(70. 5±5. 3)%,(32. 4±4. 6)%,(20. 7±4. 1)%,(17. 3±3. 4)%,F=50. 910,P=0. 000]。④安全性。双侧组2例出现邻近椎体再骨折,单侧组1例出现邻近椎体再骨折,均给予卧床休息及抗骨质疏松等治疗后骨折愈合;双侧组1例穿刺部位出现血肿,给予活血药治疗1周后血肿消退; 2组均未出现骨水泥渗漏致脊髓损伤、硬膜囊撕裂及气胸等并发症; 2组并发症发生率比较,差异无统计学意义(P=0. 603)。结论:单侧经横突-椎弓根入路PVP与双侧经椎弓根入路PVP治疗重度OVCF合并脊柱侧弯畸形,均能恢复椎体高度,矫正侧弯畸形,缓解腰背部疼痛,促进腰椎功能的恢复,住院时间短,并发症少,且骨水泥灌注量相当,但前者比后者的手术时间短、X线辐射少。

Objective:To compare the clinical curative effects and safety of percutaneous vertebroplasty(PVP)through unilateral transverse process-pedicle approach versus PVP through bilateral transpedicular approach for treatment of severe osteoporotic vertebral compression fractures(OVCF)and scoliosis.Methods:Thirty-six patients with severe OVCF and scoliosis enrolled in the study were randomly divided into 2 groups,18 cases in each group.The patients were treated with PVP through unilateral transverse process-pedicle approach(unilateral group)and PVP through bilateral transpedicular approach(bilateral group)respectively.The operative time,frequency of X-ray exposure,consumption of bone cements,hospital stays,complications and vertebral height recovery rate(ratio of postoperative increased vertebral height to postoperative vertebral height)and Cobb angle correction degree(increased degree of Cobb angle)of scoliosis measured at postoperative day 2 were compared between the 2 groups respectively.The low back pain visual analogue scale(VAS)scores and Oswestry disability index(ODI)were compared between the 2 groups before the operation and at 1 week,3 and 12 months after the operation respectively.Results:All patients in the 2 groups were followed up for 18.3+/-6.4 months.There was no statistical difference in vertebral height recovery rate and Cobb angle correction degree of scoliosis measured at postoperative day 2,consumption of bone cements and hospital stays between the 2 groups(27.6+/-5.6 vs 28.3+/-4.9%,t=0.400,P=0.700;8.2+/-2.8 vs 8.9+/-3.1 degrees,t=0.710,P=0.480;4.0+/-0.7 vs 4.2+/-0.8 mL,t=0.800,P=0.430;9.5+/-2.1 vs 9.6+/-2.2 days,t=0.140,P=0.890).The operative time was shorter and the X-ray exposure was fewer in unilateral group compared to bilateral group(23.4+/-4.3 vs 32.6+/-5.6 minutes,t=5.530,P=0.000;5.8+/-0.8 vs 9.7+/-1.1 times,t=12.170,P=0.000).There was no interaction between time factor and group factor in low back pain VAS scores(F=2.520,P=0.270).There was no statistical difference in low back pain VAS scores between the 2 groups,in other words,there was no group effect(F=1.420,P=0.150).There was statistical difference in low back pain VAS scores between different timepoints before and after the operation,in other words,there was time effect(F=34.620,P=0.000).The low back pain VAS scores presented a time-dependent decreasing trend in both of the 2 groups,and the 2 groups were consistent with each other in the decreasing trend of low back pain VAS scores(6.7+/-0.9,2.8+/-1.2,2.2+/-0.7,1.6+/-0.7 points,F=8.870,P=0.000;6.6+/-0.8,2.8+/-1.1,2.0+/-0.6,1.4+/-0.7 points,F=6.320,P=0.000).There was no interaction between time factor and group factor in ODI(F=20.360,P=0.380).There was no statistical difference in ODI between the 2 groups,in other words,there was no group effect(F=3.440,P=0.640).There was statistical difference in ODI between different timepoints before and after the operation,in other words,there was time effect(F=25.480,P=0.000).The ODI presented a time-dependent decreasing trend in both of the 2 groups,and the 2 groups were consistent with each other in the decreasing trend of ODI(68.1+/-6.1,32.6+/-5.9,22.2+/-3.8,18.2+/-2.6%,F=22.740,P=0.000;70.5+/-5.3,32.4+/-4.6,20.7+/-4.1,17.3+/-3.4%,F=50.910,P=0.000).Adjacent vertebrae fractures were found in 2 patients in bilateral group and 1 patient in unilateral group,and the fractures healed after rest in bed and anti-osteoporosis treatment.The hematoma was found at the puncture site after the operation in 1 patient in bilateral group,and it subsided after 1-week treatment with blood-activating drugs.No complications such as spinal cord injuries which was caused by bone cement leakage and dural sac avulsion and aerothorax were found in the 2 groups.There was no statistical difference in complication incidences between the 2 groups(P=0.603).Conclusion:Both PVP through unilateral transverse process-pedicle approach and PVP through bilateral transpedicular approach can restore vertebral height,correct scoliosis deformity,relieve low back pain and promote lumbar function recovery in treatment of severe OVCF and scoliosis with short hospital stays and few complications,and they are similar to each other in consumption of bone cements,while the former has the advantages of shorter operative time and less X-ray radiation compared to the latter.