单侧多方向弯曲与直行椎体成形治疗胸腰椎骨质疏松性压缩骨折优势的比较

Comparison of advantages between unilateral multidirectional curved and straight vertebroplasty in the treatment of thoracolumbar osteoporotic vertebral compression fracture

背景:近年来采用单侧穿刺的可弯曲椎体成形方法被运用于临床,其相对于传统的直行入路有无优势目前尚无定论。目的:通过与两种直行椎体成形的比较,了解单侧多方向弯曲椎体成形治疗胸腰椎骨质疏松性椎体压缩骨折的优势。方法:选择2017年1月至2019年12月广州市花都区人民医院(南方医科大学附属花都医院)收治的胸腰椎单一节段骨质疏松性压缩骨折患者85例,其中男21例,女64例,年龄65-91岁,分3组治疗,A组(n=25)进行单侧多方向弯曲椎体成形治疗,B组(n=32)进行单侧直行椎体成形治疗,C组(n=28)进行双侧直行椎体成形治疗。比较3组间骨水泥注入量、骨水泥渗漏率、再骨折发生率及骨水泥分布良好率;比较3组术前及术后1 d、12个月的椎体高度压缩率、局部后凸Cobb角、目测类比评分与术后12个月的Oswestry功能障碍指数。试验方案已获得广州市花都区人民医院伦理审批。结果与结论:①B组骨水泥注入量少于A、C组(P<0.05),再骨折发生率高于A、C组(P<0.05);A组骨水泥渗漏率低于B、C组(P<0.05),骨水泥分布良好率高于B组;②3组患者术后的椎体高度压缩率、局部后凸Cobb角均低于术前(P<0.05),A组术后12个月的椎体高度压缩率、局部后凸Cobb角低于B、C组(P<0.05);③3组患者术后的目测类比评分、Oswestry功能障碍指数均低于术前(P<0.05),3组间术后1 d、12个月的目测类比评分比较差异无显著性意义(P>0.05),3组间术后12个月的Oswestry功能障碍指数比较差异无显著性意义(P>0.05);④结果表明,弯曲和直行椎体成形治疗胸腰椎骨质疏松性椎体压缩骨折均能获得良好的近期临床疗效,但单侧多方向弯曲椎体成形在减少骨水泥渗漏、维持椎体高度和Cobb角方面更有优势。

BACKGROUND:In recent years,the new method of curved vertebroplasty had been applied in clinic.It remains unclear whether there is any advantage over the traditional straight approach.OBJECTIVE:To investigate the advantages of unilateral multidirectional curved vertebroplasty in the treatment of thoracolumbar osteoporotic vertebral compression fractures by comparing with two kinds of straight vertebroplasty.METHODS:From January 2017 to December 2019,85 patients with osteoporotic vertebral compression fractures undergoing thoracolumbar vertebroplasty in Guangzhou Huadu District People’s Hospital(Huadu Hospital,Southern Medical University)were enrolled in this study.There were 21 males and 64 females at the age of 65 to 91 years.They were divided into group A(unilateral multidirectional curved;n=25),group B(unilateral straight line;(n=32),and group C(bilateral straight line;n=28).The bone cement injection volume,leakage rate,refracture rate,and bone cement good distribution rate were compared among groups.The vertebral height compression ratio,local kyphotic Cobb angle,visual analogue scale at 1 day and 12 months after surgery,and Oswestry Dysfunction Index at 12 months were compared among the three groups.The protocols were approved by the Ethics Committee of Guangzhou Huadu District People’s Hospital(Huadu Hospital,Southern Medical University).RESULTS AND CONCLUSION:(1)The bone cement injection volume in group B was less than that in groups A and C(P<0.05).The refracture rate was higher in group B than that in groups A and C(P<0.05).The leakage rate in group A was lower than that in groups B and C(P<0.05).The bone cement good distribution rate was higher in group A than that of group B.(2)The vertebral height compression ratio and local kyphotic Cobb angle of the three groups were lower after the operation than those before the operation(P<0.05).The vertebral height compression ratio and local kyphotic Cobb angle of group A were lower than groups B and C at 12 months after operation(P<0.05).(3)The postoperative visual analogue scale scores and Oswestry Dysfunction Index of the three groups were lower than those before the operation(P<0.05).There was no significant difference in the visual analogue scale scores of the three groups at 1 day and 12 months after surgery(P>0.05).There was no significant difference in the Oswestry Dysfunction Index at 12 months after the operation among the three groups(P>0.05).(4)Both curved and straight vertebroplasty could achieve good short-term clinical results,but unilateral multi-directional vertebroplasty had more advantages in reducing bone cement leakage and maintaining vertebral height and Cobb angle.