单侧入路椎体成形术治疗骨质疏松性胸腰椎骨折

Percutaneous vertebroplasty through unilateral extrapedicular approach for osteoporotic thoracolumbar vertebral compression fractures

[目的]评价经单侧椎弓根偏外侧入路椎体成形术(PVP)治疗骨质疏松性胸腰椎压缩性骨折的疗效及安全性.[方法] 2016年5月~2017年11月本院收治的58例单节段骨质疏松性胸腰椎压缩性骨折患者,随机分为两组.单侧穿刺组30例采用经单侧椎弓根偏外侧入路行PVP手术;双侧穿刺组28例采用经双侧椎弓根入路行PVP手术.比较两组患者临床结果.[结果]单侧穿刺组骨水泥注入量较双侧穿刺组显著减少(P<0.05),但两组间骨水泥渗漏率差异无统计学意义(P>0.05).单侧穿刺组手术时间较双侧穿刺组明显缩短(P<0.05),术中X线透视次数较双侧穿刺组显著减少(P<0.05).两组患者术后VAS评分及ODI评分均较术前显著降低(P<0.05),但相同时间点两组间差异无统计学意义(P>0.05).在影像测量方面,两组患者术前骨折椎体前缘高度差异无统计学意义(P>0.05),术后椎体高度均较术前显著改善(P<0.05),但术后两组间比较,差异无统计学意义(P>0.05).[结论]经单侧椎弓根偏外侧入路及经双侧椎弓根入路PVP治疗骨质疏松性胸腰椎压缩性骨折,均能有效缓解疼痛,提高患者术后生活质量.但前者的手术时间更短,术中X线透视次数更少,可减少术中医源性放射线损伤.

[Objective] To evaluate the clinical outcome and safety of unilateral extrapedicular percutaneous vertebroplasty(PVP) for treatment of osteoporotic thoracolumbar vertebral compression fractures. [Methods] From May 2016 to November2017, 58 patients with single-segment osteoporotic thoracolumbar vertebral compression fractures were included into this study,and divided into two groups randomly. Of them, 30 patients in the unilateral group had PVP conducted through the unilateral extrapedicular approach, while 28 patients in the bilateral group received bipedicular PVP. The clinical data and outcomes were compared between the two groups. [Results] The amount of bone cement injected in the unilateral group was significantly less than that of the bilateral group(P<0.05), nevertheless no a statistically significant difference was proved in incidence of cement leakage between them(P>0.05). The operation time and the radiology exposure times in the unilateral group was significantly less than those of the bilateral group(P<0.05). The VAS and ODI scores significantly decreased in both groups after surgery(P<0.05), whereas no statistically significant differences were proved at any corresponding time point between them(P>0.05). In the aspect of radiographic measures, both groups had significantly higher relative anterior vertebral height after surgery(P<0.05), despite of the fact that no statistically significant differences was found postoperatively between the two groups(P>0.05).[Conclusion] PVP through unilateral extrapedicular approach or bipedicular approach can relieve pain and improve postoperative life quality of patients with osteoporotic thoracolumbar vertebral compression fractures. However, the former has the advantages of shorter operation time and less X-ray exposure time that can reduce radiation damage.