单侧与双侧入路经皮椎体后凸成形术治疗老年骨质疏松性椎体压缩骨折的疗效比较

Comparison of unilateral and bilateral approach percutaneous kyphoplasty in the treatment of osteoporotic thoracolumbar compression fractures in the elderly

目的比较单侧与双侧入路经皮椎体后凸成形术(PKP)治疗老年骨质疏松性椎体压缩骨折(OVCF)的疗效。方法将60例OVCF患者根据手术入路不同分为单侧组(采用单侧入路PKP治疗,30例)和双侧组(采用双侧入路PKP治疗,30例)。记录手术情况,比较两组伤椎前缘及中部高度比,采用Cobb角、疼痛VAS评分、日常生活能力量表(ADL)评分评价疗效。结果患者均获得随访,时间10~29个月。双侧组2例术中发生骨水泥渗漏,单侧组无骨水泥渗漏发生。手术时间、术中透视次数、骨水泥注入量单侧组均短(少)于双侧组(P<0.05)。术后3 d及术后6个月伤椎前缘高度比、伤椎中部高度比:两组均较术前明显恢复(P<0.05),两组间比较差异均无统计学意义(P>0.05)。术后3 d及术后6个月Cobb角、疼痛VAS评分、ADL评分:两组均较术前改善(P<0.05),两组间比较差异均无统计学意义(P>0.05)。结论单侧与双侧入路PKP治疗OVCF均可获得良好的手术疗效,单侧入路有手术时间短、术中透视次数少、骨水泥注射量少的优点。

Objective To compare the efficacy of unilateral and bilateral approach percutaneous kyphoplasty(PKP)in the treatment of elderly patients with osteoporotic vertebral compression fracture(OVCF).Methods According to the different surgical approaches,60 patients with OVCFs were divided into unilateral group(unilateral PKP treatment,30 cases)and bilateral group(bilateral PKP treatment,30 cases).The operation conditions were recorded,and the ratio of anterior edge height and the ratio of middle vertebral height in the injured vertebrae were compared between the two groups.The efficacy was evaluated by Cobb angle,pain VAS and activity of daily living scale(ADL).Results All patients were followed up for 10~29 months.Bone cement leakage occurred in 2 patients in bilateral group and no bone cement leakage occurred in unilateral group.Operation time,intraoperative fluoroscopy times and bone cement injection volume in unilateral group were shorter(less)than those in bilateral group(P<0.05).At 3 d and 6 months postoperation,the ratio of injured vertebral anterior edge and ratio of middle vertebral height of injured vertebrae were restored significantly,compared with the preoperation(P<0.05),while there were no statistical significance between the two groups(P>0.05).At 3 d and 6 months after surgery,Cobb angle,pain VAS and ADL were improved than the preoperation(P<0.05),and there were no statistical significance between the two groups(P>0.05).Conclusions Unilateral and bilateral approach PKP have the same curative effect.Unilateral approach has the advantages of shorter operation time,fewer intraoperative fluoroscopy times and less bone cement injection volume.