单双侧经皮穿刺椎体成形术治疗骨质疏松性胸腰椎椎体骨折的临床疗效

Effect of unilateral or bilateral percutaneous vertebroplasty for osteoporotic thoracolumbar vertebral fractures

目的观察并比较单双侧经皮穿刺椎体成形术(PVP)在治疗骨质疏松性胸腰椎压缩性骨折中的疗效及其对患者生活质量的影响。方法选择2016年5月至2018年6月在我院治疗的老年骨质疏松性胸腰椎压缩性骨折患者100例,根据治疗方法不同分为单侧组和双侧组,每组50例,单侧组行单侧PVP,双侧组行双侧PVP。记录2组患者手术时间以及出血量;利用视觉模拟评分(VAS)测定患者术前1 d和术后12个月的疼痛程度;采用日常生活活动能力评分(ADL)、JOA评分以及Oswestry功能障碍指数(ODI)对患者日常生活活动能力、人体功能性障碍和功能障碍改善情况进行评估,并比较术前1 d和术后12个月患者椎体前缘高度比和矢状面凹角;采用生活质量问卷对患者术后12个月生活质量(QOL)进行评估。结果单侧组患者手术时间短于双侧组,术中出血量少于双侧组,差异有统计学意义(P <0.05);与术前1 d相比,术后12个月2组患者VAS评分和ODI均降低,JOA评分均上升,差异均有统计学意义(P <0.05),而2组患者术前1 d和术后12个月ODI及VAS、JOA评分组间比较,差异均无统计学意义(P> 0.05);术后12个月2组患者椎体前缘高度比和矢状面凹角较术前1 d明显改善,差异有统计学意义(P <0.05),而2组患者术前1 d和术后12个月椎体前缘高度比和矢状面凹角组间比较,差异均无统计学意义(P> 0.05);2组患者术后12个月ADL评分均较术前1 d明显提高(P <0.05),但组间比较差异无统计学意义(P> 0.05);术后12个月2组患者QOL评分显著高于术前1 d,且单侧组患者QOL评分高于双侧组,差异均有统计学意义(P <0.05)。结论单侧和双侧PVP均有良好的疗效,均可明显改善患者生活质量。相较于双侧PVP,单侧PVP可明显缩短手术时间,减少创伤,提高患者生活质量,治疗效果更好。

Objective To observe and compare the efficacy of unilateral and bilateral percutaneous vertebroplasty( PVP) for the treatment of osteoporotic thoracolumbar vertebral compression fractures,and to compare the effect on the quality of life of patients. Methods A total of 100 elderly patients with osteoporotic thoracolumbar compression fractures who were admitted into our hospital from May 2016 to June2018 were divided into unilateral group and bilateral group according to different surgical methods,with 50 cases in each group. Patients in unilateral group were treated with unilateral percutaneous puncture vertebroplasty and patients in bilateral group were treated with bilateral percutaneous vertebroplasty. The operation time and bleeding volume of patients were recorded. The visual analogue scale( VAS) was used to determine the degree of pain at 1 day before operation and 12 months after operation. The activities of daily living( ADL) score,JOA score,and Oswestry disability index( ODI) were used to evaluate the daily living activities,functional disorder and the improvement of dysfunction,and the ratio of anterior vertebral height and the sagittal concave angle were compared at 1 day before surgery and 12 months after surgery.Quality of life questionnaire was used to evaluate the quality of life of patients 12 months after operation. Results The operation time and intraoperative blood loss in unilateral group were shorter or less than those in the bilateral group,the differences were significant( P < 0. 05).Compared with those at 1 day before surgery,the VAS scores and ODI of the two groups were both significantly reduced at 12 months after operation( P < 0. 05),and the JOA scores were both significantly increased,the differences were significant( P < 0. 05). However,there was no significant difference in ODI,VAS scores,and JOA scores between the two groups at 1 day before or 12 months after operation. Compared with those 1 day before operation,the ratio of anterior vertebral height and the sagittal concave angle of the two groups were both improved 12 months after operation,with significant differences( P < 0. 05). There was no statistically significant difference between the two groups at the same time point( P > 0. 05). The ADL scores of the two groups at 12 months after operation were significantly improved compared with those at 1 day before operation( P < 0. 05),but there was no significant difference in ADL scores between the two groups( P > 0. 05). The quality of life of patients in both of the two groups at 12 months after operation were higher than those at 1 day before operation,and the quality of life of patients in unilateral group was higher than that in bilateral group,the differences were statistically significant( P < 0. 05). Conclusion Both unilateral and bilateral percutaneous vertebroplasty have a good curative effect,which can significantly improve the quality of life of patients. Compared with bilateral percutaneous vertebroplasty,unilateral percutaneous vertebroplasty can significantly shorten the operation time,reduce trauma,improve the quality of life,and achieve better treatment results.