骨填充网袋单侧PKP与双侧PKP治疗骨质疏松性椎体压缩骨折的疗效比较

Comparison of Percutaneous Kyphoplasty with Bone Filling Container Via Unilateral Puncture Approach and Bilateral Puncture Approach for Osteoporotic Vertebral Compression Fractures

目的:探讨C臂机透视辅助下骨填充网袋单侧经皮椎体后凸成形术(PKP)和双侧PKP治疗骨质疏松性压缩骨折的安全性及临床疗效。方法:采用回顾性病例对照研究分析2017年1月—2019年10月福建省人民医院行经皮骨填充网袋椎体后凸成形术治疗骨质疏松性椎体压缩性骨折患者共80例(80个椎体),其中41例患者采用骨填充网袋单侧经皮椎体后凸成形术(单侧组),39例患者采用骨填充网袋双侧经皮椎体后凸成形术(双侧组)。比较两组患者手术时间、骨水泥渗漏情况,术后椎体高度恢复情况、术后骨折椎体Cobb角恢复情况等。结果:单侧组手术时间短于双侧组(P=0.041),骨水泥使用量明显少于双侧组(P=0.001);然而,双侧组患者术后椎体高度高于单侧组(P=0.043)。两组均有骨水泥渗漏情况,其中单侧组中6例,双侧组18例,但均未出现严重并发症。在随访过程中,两组中分别有3例患者由于不同原因发生术后再发骨折。结论:与骨填充网袋双侧经皮椎体后凸成形术相比,单侧经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折可以显著缩短手术时间、减少骨水泥使用量、减小骨水泥渗漏风险,且其在缓解疼痛,纠正后凸畸形、术后再发骨折等方面可以取得与双侧椎弓根入路相类似的疗效。

Objective:The aim of this study is to compare the safety and efficacy of percutaneous kyphoplasty with bone filling container via unilateral puncture approach and bilateral puncture approach for treating osteoporotic vertebral compression fracture.Methods:A retrospective case-control study was conducted to analyze a total of 80 patients(80 vertebral bodies)who underwent percutaneous kyphoplasty with bone filling container for osteoporotic vertebral compression fracture in Fujian People’s Hospital from January 2017 to October 2019.There are 41 patients underwent unilateral approach percutaneous kyphoplasty with bone filling container(unilateral group),and 39 patients underwent bilateral approach percutaneous kyphoplasty with bone filling container(bilateral group).The operative time,the rate of bone cement leakage,postoperative vertebral height and postoperative Cobb angle of fractured vertebral body were recorded and compared between the two groups.Results:The operation time of the unilateral group was significantly shorter than that in the bilateral group(P=0.041),and the amount of bone cement was significantly lower than that in the bilateral group(P=0.001).However,the postoperative vertebral body height of the bilateral group was significantly higher than that of the unilateral group(P=0.043).Both of groups cases of bone cement leakage,there were 6 patients unilateral group and 18 patients in bilateral group,but all of which did not present serious complications.During the follow-up,there were 3 patients in each group who had recurrent osteoporotic vertebral compression fracture after percutaneous kyphoplasty surgery.Conclusion:Compared with bilateral percutaneous kyphoplasty,unilateral approach percutaneous kyphoplasty with bone filling container for treating osteoporotic vertebral compression fracture can significantly shorten the operation time,decrease the usage amount of bone cement and decrease the risk of bone cement leakage,and it can achieve similar results in relieving pain and correcting kyphosis.