单双侧液压输送高黏度骨水泥经皮椎体成形术治疗骨质疏松性椎体压缩性骨折的临床分析

Clinical analysis of percutaneous vertebroplasty with unilateral and bilateral hydraulic delivery of high viscosity bone cement in the treatment of osteoporotic vertebral compression fractures

目的比较分析经皮椎体成形术(PVP)治疗骨质疏松性椎体压缩性骨折(OVCF)患者采用单双侧液压输送高黏度骨水泥的效果。方法采用前瞻性对照研究2016年1月-2018年11月濮阳市油田总医院收治的OVCF患者118例。随机抽签法分为单侧组(59例)及双侧组(59例)。单侧组男性37例,女性22例;年龄61~88岁,平均72.3岁;跌伤40例,道路交通伤19例。双侧组男性39例,女性20例;年龄60~86岁,平均72.3岁;跌伤42例,道路交通伤17例。单侧组行单侧液压输送高黏度骨水泥PVP,双侧组行双侧液压输送高黏度骨水泥PVP。比较两组患者手术时间、术中透视次数、骨水泥注入量、手术前后椎体高度与Cobb角,术前、术后6个月VAS评分及功能障碍指数(ODI),骨水泥渗漏发生情况。结果单侧组手术时间、术中透视次数以及骨水泥注入量均少于双侧组[(34.23±9.01)min vs.(55.22±6.38)min、(19.42±6.22)次vs.(31.05±7.54)次、(3.21±0.42)m L vs.(5.07±0.69)m L,P<0.05]。单侧组与双侧组术后椎体前缘高度均高于术前[(2.15±0.57)cm vs.(2.01±0.74)cm、(2.20±0.58)cm vs.(2.00±0.73)cm],而Cobb角小于术前[(8.52±4.34)°vs.(10.75±6.23)°、(8.04±4.45)°vs.(10.68±6.20)°,P<0.05];但两组患者术前、术后的椎体前缘高度、椎体中间高度、椎体后缘高度、Cobb角比较,差异无统计学意义(P>0.05)。单侧组与双侧组术后6个月VAS评分、ODI指数均低于术前[(1.24±0.31)分vs.(7.04±0.52)分、(1.30±0.32)分vs.(7.01±0.54)分]、[(23.14±6.02)%vs.(71.42±11.49)%、(23.20±6.04)%vs.(71.39±11.50)%,P<0.05];但单侧组与双侧组术前、术后6个月VAS评分、ODI指数比较,差异无统计学意义(P>0.05)。单侧组骨水泥渗漏发生率为5.08%,低于双侧组的18.64%(P<0.05)。结论单双侧液压输送高黏度骨水泥PVP对OVCF患者椎体高度、Cobb角以及疼痛、功能的改善效果相当。然而,单侧液压输送高黏度骨水泥PVP具有手术时间较短、术中透视次数、骨水泥注入量较少以及骨水泥渗漏发生风险较低的优势,临床工作中可按照患者具体情况选择合理的治疗术式。

Objective To compare and analyze the effects of unilateral and bilateral hydraulic delivery of high viscosity bone cement in patients with osteoporotic vertebral compression fracture(OVCF)treated with percutaneous vertebroplasty(PVP).Methods A prospective control study was conducted in 118 OVCF patients,who were admitted to Puyang Oilfield General Hospital from Jan.2016 to Nov.2018.They were divided into unilateral group(n=59 cases)and bilateral group(n=59 cases)by random number table method.In the unilateral group,there were 37 males and 22 females,aged 61-88 years,with an average age of 72.3 years,and 40 patients were suffered from falls and 19 from road traffic injuries.There were 39 males and 20 females in the bilateral group,aged 60-86 years,with an average age of 72.3 years,and 42 patients suffered from falls and 17 from road traffic injuries.The unilateral group received PVP treatment with unilateral hydraulic transport of high viscosity bone cement,while the bilateral group received PVP treatment with bilateral hydraulic transport of high viscosity bone cement.The operation time,times of intraoperative fluoroscopy and bone cement injection volume,the height of vertebral body and Cobb’s angle before and after the operation,VAS score and Oswestry disability index(ODI)before and 6 months after the operation,and the leakage of bone cement were compared between the two groups.Results The operation time,times of intraoperative fluoroscopy and bone cement injection volume in the unilateral group were less than those in the bilateral group[(34.23±9.01)min vs.(55.22±6.38)min,(19.42±6.22)times vs.(31.05±7.54)times,(3.21±0.42)m L vs.(5.07±0.69)m L,P<0.05].The height of anterior edge of vertebral body in unilateral group and bilateral group was higher than that before operation[(2.15±0.57)cm vs.(2.01±0.74)cm,(2.20±0.58)cm vs.(2.00±0.73)cm],while Cobb’s angle was smaller than that before operation[(8.52±4.34)°vs.(10.75±6.23)°,(8.04±4.45)°vs.(10.68±6.20)°,P<0.05].However,there was no significant difference between the two groups in anterior edge height,middle height,posterior edge height of vertebral body,or Cobb’s angle before and after operation(P>0.05).The VAS and ODI of the unilateral group and bilateral group were lower than those of the preoperative[(1.24±0.31)vs.(7.04±0.52),(1.30±0.32)vs.(7.01±0.54),(23.14±6.02)vs.(71.42±11.49),(23.20±6.04)vs.(71.39±11.50),P<0.05],but there was no significant difference in VAS and ODI before and 6 months after operation between unilateral group and bilateral group(P>0.05).The rate of cement leakage in unilateral group was 5.08%,lower than 18.64%in bilateral group(P<0.05).Conclusion Unilateral and bilateral hydraulic delivery of high viscosity bone cement of PVP have similar effect on the improvement of vertebral height,Cobb’angle,pain and function in OVCF patients.However,unilateral hydraulic delivery of high viscosity bone cement has advantages such as shorter operative time,fewer intraoperative fluoroscopy times,less injection of bone cement and reduced risk of bone cement leakage.In clinical work,reasonable therapeutic methods can be selected according to the specific conditions of patients.