两种入路行经皮椎体成形治疗胸椎骨质疏松性压缩骨折:骨水泥渗漏及安全性的比较

Percutaneous vertebroplasty in treatment of osteoporotic vertebral compression fracture by two different approaches:bone cement leakage and safety

背景:临床上治疗胸椎骨质疏松性压缩骨折可选择单侧椎弓根外入路或双侧椎弓根入路完成经皮椎体成形手术,但两种不同入路方式的骨水泥渗漏情况及安全性报道较少。目的:比较单侧椎弓根外入路与双侧椎弓根入路行经皮椎体成形治疗胸椎骨质疏松性压缩骨折的骨水泥渗漏情况与安全性。方法:选择河北北方学院附属第一医院2018年1月至2020年12月收治的60例胸椎骨质疏松性压缩骨折患者,按照手术入路分为2组,30例经单侧椎弓根外入路进行经皮椎体成形骨水泥注射治疗,另30例经双侧椎弓根入路进行经皮椎体成形骨水泥注射治疗。对比两组的骨水泥灌注量、骨水泥渗漏率及其他并发症发生情况,以及病椎后凸角、目测类比评分与Oswestry功能障碍指数得分情况。结果与结论:①两组骨水泥灌注量与骨水泥渗漏率比较差异无显著性意义(P>0.05)。②两组术后1 d、3 d、1个月的目测类比评分与Oswestry功能障碍指数得分均低于术前(P<0.05),病椎后凸角小于术前(P<0.05),两组间术后各时间点的目测类比评分、Oswestry功能障碍指数得分与病椎后凸角比较差异均无显著性意义(P>0.05)。③结果表明,经单侧椎弓根外入路和双侧椎弓根入路行经皮椎体成形骨水泥注射治疗胸椎骨质疏松性压缩骨折均可获得满意的临床效果。

BACKGROUND:Clinical therapies of osteoporotic vertebral compression fracture have two different approaches,including unilateral pedicle extrapedicle and bilateral pedicle approach of percutaneous vertebroplasty,but there were fewer reports about postoperative bone cement leakage rate and security in the two approaches.OBJECTIVE:To compare postoperative bone cement leakage rate and security with osteoporotic vertebral compression fracture by two different approaches,unilateral pedicle extrapedicle and bilateral pedicle approach of percutaneous vertebroplasty.METHODS:This study enrolled 60 cases with the osteoporotic vertebral compression fracture who were patients meeting the inclusion criteria in the First Affiliated Hospital of Hebei North University from January 2018 to December 2020.The 60 cases were randomly divided into two groups according to surgical approach.Group A(n=30)was treated with unilateral pedicle extrapedicle approach of percutaneous vertebroplasty.Group B(n=30)was treated with bilateral pedicle approach of percutaneous vertebroplasty.The volume of bone cement injection,bone cement leakage rate and other complications,as well as kyphosis angle of the compressive vertebral body,the visual analogue scale score,and Oswestry disability index were compared between the two groups.RESULTS AND CONCLUSION:(1)There was no statistical significance in the volume and leakage rate of bone cement injection in two groups(P>0.05).(2)Visual analogue scale score and Oswestry disability index were significantly lower at 1,3 days,and 1 month after surgery compared with that preoperatively in both groups(P<0.05).Postoperative kyphosis angle of the compressive vertebral body was less than that preoperatively(P<0.05).There was no statistical difference in visual analogue scale score,Oswestry disability index,and kyphosis angle at various time points after surgery in both groups(P>0.05).(3)The results suggest that satisfactory clinical effect can be obtained by two different approaches,unilateral pedicle extrapedicle and bilateral pedicle approach of percutaneous vertebroplasty.