单侧与双侧入路PVP治疗骨质疏松性椎体压缩骨折的近期临床疗效观察

The short-term clinical outcomes of unipedicular and bipedicular percutaneous vertebroplasty for osteoporotic vertebral compression fractures

目的比较单侧与双侧经椎弓根入路经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗骨质疏松性椎体压缩骨折的临床疗效。方法回顾性分析2016年1月至2018年5月于我院行PVP治疗的78例单个椎体骨质疏松性椎体压缩骨折患者资料,根据手术入路不同分为两组:单侧组33例,男6例,女27例,年龄56~100岁,平均(74.2±9.6)岁;双侧组45例,男6例,女39例,年龄57~94岁,平均(75.0±8.3)岁。统计分析两组患者的疼痛视觉模拟评分(VAS)、手术时间、骨水泥注入量、骨水泥渗漏率、手术前后骨折椎体压缩程度、手术前后骨折椎体后凸Cobb角、术后骨折椎体前缘高度恢复率及后凸Cobb角恢复率。结果两组患者术后疼痛症状均较术前明显改善,组内术后VAS评分均明显低于术前,差异有统计学意义(P<0.05);但两组间术后VAS评分差异无统计学意义(P>0.05)。单侧入路组平均手术时间(56.9±29.7) min较双侧入路组(71.1±25.7) min短,骨水泥平均注入量(2.6±1.0) mL较双侧入路组(4.1±1.1) mL少,差异有统计学意义(P<0.05)。单侧入路组骨水泥渗漏率18.2%(6/33)略高于双侧入路组15.6%(7/45),但两组差异无统计学意义(P>0.05)。两组术后椎体压缩程度及后凸Cobb角均较术前改善,差异有统计学意义(P<0.05),但两组间术后椎体高度恢复率及后凸Cobb角恢复率差异均无统计学意义(P>0.05)。结论采用单侧与双侧经椎弓根入路PVP治疗骨质疏松性椎体压缩骨折,均能取得良好的治疗效果,但单侧入路组手术时间短、穿刺损伤小。

Objective To compare the clinical outcomes of unipedicular percutaneous vertebroplasty (PVP) with that of bipedicular PVP in the treatment of osteoporotic vertebral compression fractures. Methods Seventy eight patients with single osteoporotic vertebral compression fractures were treated by PVP from January 2016 to May 2018. They were divided into two groups according to their surgical approach. There were 33 cases in the unilateral group, including 6 males and 27 females, aged from 56 to 100 years, with an average age of (74.2±9.6) years;and there were 45 cases in the bilateral group, including 6 males and 39 females, aged from 57 to 94 years, with an average age of (75.0±8.3) years. Clinical outcomes were assessed by using visual analogue scale (VAS), operation time, injection volume of bone cement, rate of cement leakage, compression ratio and kyphotic Cobb angle of fracture vertebral before and after surgery, restoration ratio of the vertebral height and correction ratio of the kyphotic Cobb angle after surgery. Results The postoperative VAS were significantly lower than preoperative VAS (P<0.05) in both groups, but there was no significant difference between the two groups in analgesic effect after PVP (P>0.05). In the unilateral group, the average operative time (56.9±29.7) min and the average amount of bone cement injection (2.6±1.0) mL were significantly less than that of the bilateral group,(71.1±25.7) min and (4.1±1.1) mL (P<0.05). No significant difference was observed between the unilateral group (18.2%, 6/33) and the bilateral group (15.6%, 7/45) at the rate of bone cement leakage (P>0.05). The compression ratio and kyphotic Cobb angle of fracture vertebral were statistically improved in both two groups after surgery (P<0.05);furthermore, there was no significant difference between the two groups in the restoration ratio of the vertebral height and correction ratio of the kyphotic Cobb angle after surgery (P>0.05). Conclusion The short-term clinical effects of unipedicular PVP are as same as that of bipedicular PVP in the treatment of osteoporotic vertebral compression fractures, and the unipedicular PVP had shorter operation time and less trauma.