经椎弓根外单侧穿刺法行PVP治疗骨质疏松性椎体压缩骨折的前瞻性研究

Prospective study of percutaneous vertebroplasty through unilateral extreme extrapedicular approach for osteoporotic vertebral compression fracture

目的比较经椎弓根双侧穿刺法和经椎弓根外单侧穿刺法行经皮穿刺椎体成形术(PVP)治疗骨质疏松性椎体压缩骨折的临床疗效。方法采用前瞻性队列研究方法,选取2016年1月—2018年1月首都医科大学附属北京友谊医院收治的97例骨质疏松性椎体压缩骨折的患者,男性36例,女性61例;年龄(72.19±7.41)岁,年龄范围60~88岁。患者采用不同的穿刺方法后行PVP,根据穿刺方法的不同将患者分为单侧穿刺组(n=52)和双侧穿刺组(n=45),单侧穿刺组患者采用经椎弓根外单侧穿刺法完成PVP,双侧穿刺组患者采用经椎弓根双侧穿刺法完成PVP,所有的患者均完成术后至少1年的门诊随访。观察2组患者的手术时间、透视次数、骨水泥用量、骨水泥渗漏发生率、术后1周和术后1年的视觉模拟评分(VAS)。计量资料以均数±标准差(Mean±SD)表示,计数资料以百分比表示;组间比较采用独立样本t检验和χ2检验,组内比较采用配对t检验。结果2组均顺利完成手术,无截瘫、骨水泥过敏、肺栓塞等严重手术并发症发生。单侧穿刺组的手术时间为(21.90±3.16)min、术中透视次数为(15.46±2.86)次、骨水泥用量为(3.47±0.41)ml,骨水泥渗漏发生率为44.23%(23/52);双侧穿刺组的手术时间为(31.64±6.90)min、术中透视次数为(23.31±2.39)次、骨水泥用量为(4.66±0.61)ml,骨水泥渗漏发生率为68.89%(31/45)。单侧穿刺组的手术时间、术中透视次数、骨水泥用量以及骨水泥渗漏发生率均明显少于双侧穿刺组,差异有统计学意义(P<0.05)。单侧穿刺组术前VAS为(8.18±0.77)分,术后1周VAS为(3.39±0.69)分,术后1年VAS为(1.07±0.90)分;双侧穿刺组术前VAS为(7.93±0.92)分,术后1周VAS为(3.14±0.83)分,术后1年VAS为(0.90±0.82)分。与术前相比,2组患者术后1周和术后1年的VAS均显著下降,差异有统计学意义(P<0.05)。但VAS在术后1周和术后1年的组间比较中,差异无统计学意义(P>0.05)。结论与经椎弓根双侧穿刺法相比,经椎弓根外单侧穿刺法行PVP可以达到相同的术后疗效,但后者可以明显缩短手术时间、减少术中骨水泥用量和透视次数、降低骨水泥渗漏的发生率。

Objective To compare the clinical outcomes of unilateral extreme extrapedicular puncture versus bilateral transpedicular puncture in percutaneous vertebroplasty(PVP)for osteoporotic vertebral compression fracture.Methods A prospective cohort study was performed.Ninety-seven patients of osteoporotic vertebral compression fractures treated were selected from January 2016 to January 2018 in Beijing Friendship Hospital,Capital Medical University.There were 36 males and 61 females,aged(72.19±7.41)years,with an age range of 60-80 years.All the patients underwent PVP with different puncture methods were divided into unilateral puncture group(n=52)and bilateral puncture group(n=45).PVP was performed in the unilateral extreme extrapedicular puncture group by unilateral puncture of the pedicle,and PVP was performed by bilateral puncture of the pedicle in the bilateral transpedicular puncture group.All patients completed at least one year of follow-up after operation.The operation time,fluoroscopy times,cement volume,incidence of cement leakage,visual analogue score(VAS)of 1 week and 1 year after operation were observed.The measurement data were expressed as mean±standard deviation(Mean±SD),count data were expressed as percentage,the independent sample t test and theχ2 test were used for comparison between groups,and the paired t test was used for comparison within the group.Results The operation was successfully completed in both groups.No serious complications such as paraplegia,bone cement allergy,pulmonary embolism were occurred.In the unilateral puncture group,the operation time were(21.90±3.16)min,the fluoroscopy times were(15.46±2.86)times,the cement volume were(3.47±0.41)ml and the incidence of cement leakage was 44.23%(23/52),in the bilateral puncture group,the operation time were(31.64±6.90)min,the fluoroscopy times were(23.31±2.39)times,the cement volume were(4.66±0.61)ml and the incidence of cement leakage was 68.89%(31/45).The operation time,fluoroscopy times,cement volume and incidence of cement leakage of unilateral puncture group were significantly less than those of bilateral puncture group.The difference was statistically significant(P<0.05).The VAS score in unilateral puncture group was(8.18±0.77)scores in preoperation,(3.39±0.69)scores in 1 week,(1.07±0.90)scores in 1 year.The VAS score in bilateral puncture group was(7.93±0.92)scores in preoperation,(3.14±0.83)scores in 1 week and(0.90±0.82)scores in 1 year.Compared with pre-operation,the VAS scores of the two groups decreased significantly at 1 week and 1 year after operation,and the difference was statistically significant(P<0.05).However,there was no significant difference in VAS between groups at 1 week after operation and 1 year after operation(P>0.05).Conclusions Compared with bilateral transpedicular puncture,PVP through unilateral extrapedicular puncture can achieve the same clinical effect.However,the latter can significantly reduce the operation time,the cement volume,fluoroscopy times and the incidence of cement leakage.