经椎体后上缘入路椎体后凸成形术治疗腰椎骨质疏松性椎体压缩骨折的临床疗效

Clinical effect of percutaneous kyphoplasty via posterior-superior vertebral margin in the treatment of osteoporotic vertebral compression fractures of the lumbar spine

目的 :分析经椎体后上缘入路椎体后凸成形术(percutaneous kyphoplasty,PKP)的手术设计,并与经双侧椎弓根入路PKP治疗骨质疏松性腰椎椎体压缩性骨折(osteoporotic vertebral compression fracture,OVCF)进行临床疗效对比。方法:回顾性分析符合纳入标准并行PKP治疗的患者67例,共74个椎体,按照患者接受PKP的不同入路手术分为经椎体后上缘入路组(观察组)与经双侧椎弓根入路组(对照组)。其中观察组男6例,女23例,平均年龄76.8±8.8岁;对照组男9例,女29例,平均年龄77.7±10.2岁。对两组患者的椎体高度改善率、骨水泥分布及渗漏情况、穿刺角度、手术时间、术中放射暴露、骨水泥注射量、VAS评分和ODI评分进行对比分析。结果:所有患者均顺利完成手术,术中未发生穿刺相关神经损伤、节段动脉损伤等。两组患者椎体高度改善率[(47.68±23.76)%vs (48.70±22.10)%]、骨水泥注射量(4.35±1.00ml vs 4.63±0.75ml)、骨水泥单侧分布率(6.1%vs 0)、椎管内骨水泥渗漏率(27.3%vs 14.6%)、椎间盘骨水泥渗漏率(12.1%vs 9.8%)、椎间孔骨水泥渗漏率(3.0%vs 0)及术后VAS(2.10±0.90 vs 1.92±0.67)相比,差异均无统计学意义(P>0.05)。两组椎旁骨水泥渗漏率(30.3%vs 61.0%)、放射暴露、手术时间(39.2±4.7min vs 44.8±5.5min)及穿刺角度相比,差异有统计学意义(P<0.05)。结论:经椎体后上缘入路单侧穿刺即可达到椎体中心实现骨水泥双侧弥散,可减少手术时间与放射暴露,降低骨水泥椎旁渗漏率,可获得与经双侧椎弓根入路PKP相同的椎体复位率及临床疗效。

Objectives:To describe the practice design of percutaneous kyphoplasty(PKP)via posterioranterior vertebral margin and to evaluate its advantages,disadvantages and clinical efficacy compared with bilateral transpedicular approach PKP.Methods:67 patients(74 vertebrae)that meet criteria were included into the study to analyze retrospectively.Patients were divided into two groups according to the PKP approaches:observation group(PKP via posterior-anterior vertebral margin)and control group(transpedicular approach PKP).There were 6 males and 23 females in observation group,with an average age of 76.8±8.8 years.There were 9 males and 29 females in control group,with an average age of 77.7±10.2 years.Evaluation indexes included:improvement rate of vertebral height,cement distribution and leakage,puncture angle,operative time,radiation exposure,cement volume,VAS score and ODI score.Results:All the patients successfully went through the operation without puncture-related nerve injury and segmental artery injury.There were no significant differences(P>0.05)in improvement rate of vertebral height[(47.68±23.76)%vs(48.70±22.10)%],bone cement volume(4.35±1.00 ml vs 4.63±0.75 ml),unilateral cement distribution rate(6.1%vs0),intraspinal cement leakage rate(27.3%vs 14.6%),intradiscal cement leakage rate(12.1%vs 9.8%),foraminal cement leakage rate(3.0%vs 0)and postoperative VAS score(2.10±0.90 vs 1.92±0.67)between the two groups.There were significant differences(P<0.05)in paravertebral cement leakage rate(30.3%vs 61.0%),radiation exposure,operative time(39.2±4.7 min vs 44.8±5.5 min)and puncture angle between the two groups.Conclusions:PKP via posterior-anterior vertebral margin can easily reach the vertebral center and make the cement distribute on bilateral side just by unilateral operation.This approach allows shorter operative time,smaller radiation exposure and lower paravertebral cement leakage rate than bilateral transpedicular approach PKP.And it can achieve similar improvement rate of vertebral height and clinical efficacy as transpedicular approach PKP.