后凸成形术中单侧与双侧穿刺治疗骨质疏松性胸腰椎骨折的效果比较

Comparison of the effect of unilateral and bilateral puncture in the treatment of osteoporotic thoracolumbar fractures during kyphoplasty

目的:比较后凸成形术中单侧穿刺与双侧穿刺治疗骨质疏松性胸腰椎骨折的效果。方法:收集2017年10月—2018年10月行经皮椎体后凸成形术治疗的骨质疏松性胸腰椎骨折患者66例,依据随机对照原则分为观察组33例,行单侧穿刺,对照组33例行双侧穿刺,比较两组患者手术和术后并发症情况。疼痛采用视觉模拟评分法(VAS)评分,功能用Oswestry功能障碍指数(ODI)评估。术后随访6个月,观察椎体前缘高度、后凸Cobb角、腰背部疼痛和腰背部功能变化情况。结果:观察组手术总时间、X线曝光总次数及骨水泥注入总量分别为(33.44±6.52)/min、(12.66±3.23)次和(3.65±0.62)ml,对照组分别为(41.47±7.15)/min、(16.17±4.05)次和(4.82±0.77)ml,组间差异有统计学意义(P<0.05)。两组患者随访6个月时的椎体前缘高度、后凸Cobb角、VAS评分、ODI指数对比差异无统计学意义(P>0.05)。观察组骨水泥渗漏4例(12.12%),低于对照组的11例(33.33%,P<0.05)。结论:骨质疏松性胸腰椎骨折患者经皮椎体后凸成形术治疗中两种穿刺方法效果相似,但单侧穿刺更有利于缩短手术时间、减少骨水泥注入量、降低骨水泥渗漏发生率。

Objective:To compare the effect of unilateral and bilateral puncture in the treatment of osteoporotic thoracolumbar fracture during kyphoplasty.Methods:Sixty-six cases of osteoporotic thoracolumbar fracture treated by percutaneous kyphoplasty from October 2017 to October 2018 were collected,and according to the principle of randomized control divided into an observation group with 33 cases receiving unilateral puncture,and a control group with 33 cases receiving bilateral puncture,and surgery and postoperative complications were compared between the two groups.Pain was scored by visual analogue scale(VAS),and function was assessed by Oswestry dysfunction index(ODI).After 6 months follow-up,anterior height of vertebral body,the Cobb angle of kyphosis,the pain of the lumbar back and the changes of the function of the lumbar back were observed.Results:The total operation time,total number of X-ray exposures and total bone cement injection in the observation group were(33.44±6.52)/min,(12.66±3.23)times and(3.65±0.62)ml,those in control group were(41.47±7.15)/min,(16.17±4.05)times and(4.82±0.77)ml,and the differences between the groups were statistically significant(P<0.05).There were no significant differences between the two groups in the anterior height of vertebral body,Cobb angle of kyphosis,VAS score and ODI index after 6 months of follow-up(P>0.05).Bone cement leakage was 4 cases(12.12%)in the observation group,which was lower than 11 cases(33.33%)in the control group(P<0.05).Conclusion:The results of two percutaneous kyphoplasty methods in the treatment of patients with osteoporotic thoracolumbar fractures are similar,but unilateral puncture is more conducive to shorten the operation time,reduce the amount of bone cement injection,and decrease the incidence of bone cement leakage.