不同手术入路椎体成形术治疗胸腰段椎体压缩性骨折患者效果观察

Observation of the effect of vertebroplasty with different surgical approaches on patients with thoracolumbar vertebral compression fractures

目的:探讨不同手术入路的椎体成形治疗胸腰段椎体压缩性骨折患者效果观察。方法:选取2014年1月至2019年4月收治的70例胸腰段椎体压缩性骨折患者,随机分为A组和B组,均给予经皮椎体成形术治疗,其中A组给予单侧椎弓根入路,B组给予双侧椎弓根入路,比较两组手术临床指标、术前及术后1周Cobb角和视觉模拟评分法(visual analogue scale,VAS)评分、术前及术后1年Oswestry功能障碍指数。结果:A组手术时间、X线暴露次数低于B组,骨水泥注入量高于B组(P<0.05)。A组骨水泥渗漏率为14.29%、邻近椎体骨折率为14.29%,B组骨水泥渗漏率为5.71%、邻近椎体骨折率为2.86%,A组骨水泥渗漏率及邻近椎体骨折率均高于B组(P<0.05)。A组术中出血量(8.61±2.03)mL,B组术中出血量(9.01±1.86)mL,两组对比差异无统计学意义(P>0.05)。术前两组Cobb角、VAS评分差异无统计学意义(P>0.05),术后1周两组Cobb角、VAS评分均降低(P<0.05),但两组相比差异无统计学意义(P>0.05),术前两组Oswestry功能障碍指数差异无统计学意义(P>0.05),术后1年两组Oswestry功能障碍指数均降低(P<0.05),但两组相比差异无统计学意义(P>0.05)。结论:单、双侧椎弓根入路椎体成形术治疗胸腰段椎体压缩性骨折疗效相当,均可恢复椎体形态和功能,缓解患者疼痛,单侧入路手术时间短,辐射暴露低,双侧入路骨水泥注入量较少,分布均匀,能够降低骨水泥渗漏及邻近椎体骨折发生的风险。

Objective:To explore the effect of vertebroplasty with different surgical approaches on patients with thoracolumbar vertebral compression fractures.Methods:70 patients with thoracic and lumbar vertebral compression fractures admitted from January 2014 to April 2019 were randomly divided into groups A and B,all of whom were given percutaneous vertebroplasty.The group A was given a single lateral pedicle approach and the group B was given bilateral pedicle approach.The clinical indexes,Cobb angle and visual analogue scale(VAS)score preoperative and 1 week postoperative,Oswestry dysfunction index preoperative and 1 year after surgery were compared in the two groups.Results:The operation time and X-ray exposure times of group A were lower than those of group B,and the amount of bone cement injection was higher than that of group B(P<0.05).The bone cement leakage rate in group A was 14.29%,the adjacent vertebral body fracture rate was 14.29%;the bone cement leakage rate in group B was 5.71%,and the adjacent vertebral body fracture rate was 2.86%.The bone cement leakage rate and the adjacent vertebral body fracture rate were higher than those in group B(P<0.05).The intraoperative blood loss in group A was(8.61±2.03)mL,and that in group B was(9.01±1.86)mL.There was no statistically significant difference between the two groups(P>0.05).There was no significant difference in Cobb angle and VAS score between the two groups before surgery(P>0.05),and the Cobb angle and VAS score decreased in both groups at 1 week after surgery(P<0.05),but there was no statistically significant difference between the two groups(P>0.05).There was no statistically significant difference of Oswestry dysfunction index before surgery between the two groups(P>0.05),and the Oswestry dysfunction index of both groups decreased 1 year after surgery(P<0.05),but there was no significant difference between the two groups(P>0.05).Conclusion:The effects of vertebroplasty with unilateral and bilateral pedicle approach are equivalent in the treatment of thoracolumbar vertebral compression fractures.Both can restore the vertebral body shape and function and relieve the patient's pain.The unilateral approach has short operation time and radiation exposure.The bilateral pedicle approach can reduce the risk of bone cement leakage and adjacent vertebral body fractures with less injection of bone cement on both sides and even distribution.