单侧经后外上方入路椎体成形术治疗骨质疏松性椎体压缩性骨折

Percutaneous vertebroplasty via the unilateral posterolateral approach for the treatment of osteoporotic vertebral compression fractures

比较单侧经后外上方入路与双侧经椎弓根入路椎体成形术(PVP)治疗骨质疏松性椎体压缩性骨折(OVCF)的临床疗效。方法回顾性分析2018年7月至2019年6月南京医科大学附属苏州医院骨科收治的98例单椎体OVCF患者的临床资料,其中男18例,女80例,年龄61~95岁。损伤节段:T73例、T81例、T93例、T102例、T116例、T1222例、L124例、L217例、L311例、L48例、L51例。56例患者行单侧经后外上方入路PVP为单侧组,42例行双侧经椎弓根入路PVP为双侧组。比较两组患者的手术时间、术中X线透视次数、骨水泥注入量、骨水泥分布类型、骨水泥渗漏率,以及术前、术后1 d、术后3个月及末次随访时疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)。结果两组患者平均随访9.3个月,无血肿、骨水泥栓塞、脊髓或神经损伤并发症发生。单侧组手术时间短于双侧组(P<0.05),术中X线透视次数少于双侧组(P<0.05),骨水泥注入量及骨水泥渗漏率与双侧组的差异无统计学意义(P>0.05)。单侧组骨水泥分布:Ⅰ型45例,Ⅱ型9例,Ⅳ型2例;双侧组:Ⅰ型15例,Ⅲ型27例。两组患者术后VAS、ODI评分较术前均有明显改善(P<0.05),但两组间比较无差异(P>0.05)。结论单侧经后外上方入路与双侧经椎弓根入路行PVP均能有效缓解疼痛和改善功能,但单侧经后外上方入路行PVP具有手术时间短、X线透视次数少、骨水泥分布更佳的优点。

To compare the clinical outcomes of percutaneous vertebroplasty(PVP)via the unilateral posterolateral approach vs.the bilateral transpedicular approach for treatment of osteoporotic vertebral compression fractures(OVCF).Methods The cohort of this retrospective study included 98 patients(18 males and 80 females;age range,61-95 years)with single-level OVCF who were treated in the Department of Orthopedics of Suzhou Hospital Affiliated to Nanjing Medical University from July 2018 to June 2019.The fractured vertebrae were T7 in three patients,T8 in one,T9 in three,T10 in two,T11 in six,T12 in 22,L1 in 24,L2 in 17,L3 in 11,L4 in eight,and L5 in one.Of these patients,56 underwent PVP via the unilateral posterolateral approach(unilateral group)and 42 via the bilateral transpedicular approach(bilateral group).The surgical duration,fluoroscopy frequency,bone cement injection volume,bone cement distribution type,bone cement leakage rate,visual analogue scale(VAS),and Oswestry disability index(ODI)were compared between the two groups.Results At an average follow-up period of 9.3 months,there were no instances of hematoma,bone cement embolism,or injury to thespinal cord or nerves.The surgical duration and fluoroscopy frequency were significantly shorter in the unilateral group than the bilateral group(P<0.05).There were no significant differences in the volume of injected bone cement and bone cement leakage ratebetween the two groups(P>0.05).The distribution of bone cement was typeⅠin 45 patients,typeⅡin nine,and typeⅣin two in the unilateral group,and typeⅠin 15 and typeⅢin 27 in the bilateral group.The postoperative VAS and ODI of the two groups were significantly improved(P<0.05)with no significant differences between the two groups(P>0.05).Conclusion PVP via both the unilateral posterolateral and bilateral transpedicular approaches can effectively relieve pain and improve function,but the unilateral posterolateral approach conveys the advantages of a shorter surgical duration,less fluoroscopy frequency,and better distribution of bone cement.