单侧及双侧经皮椎体成形术治疗骨质疏松性胸腰椎骨折临床疗效比较

Comparison of clinical efficacy of unilateral and bilateral percutaneous vertebroplasty combined with high viscosity bone cement in the treatment of osteoporotic thoracolumbar fractures

目的评价单侧及双侧经皮椎体成形术(percutaneous vertebroplasty,PVP)联合高黏度骨水泥治疗胸腰椎骨质疏松性椎体压缩性骨折(osteoporotic vertebral compression fracture,OVCF)的临床疗效。方法2017年1月~2020年12月我院行PVP的胸腰椎OVCF病人83例,依据手术方法分为单侧组或双侧组,单侧组43例,行高黏度骨水泥单侧PVP,双侧组40例,行高黏度骨水泥双侧PVP。观察到骨折椎骨中的骨水泥分散。记录手术时间、透视频率、骨水泥注射量、椎体前缘压缩程度、后凸Cobb角、骨水泥渗漏率和视觉模拟评分(visual analogue scale,VAS)评分、ODI(The Oswestry Disability Index)评分。结果单侧组的手术时间和透视频率低于双侧组,双侧组的骨水泥注射量显着高于单侧组,差异有统计学意义(P<0.05)。与基线相比,两组术后1个月和6个月的VAS评分、ODI评分均显著降低,差异有统计学意义(P<0.05)。两组的骨水泥渗漏率比较,差异无统计学意义(P>0.05)。结论单侧或双侧入路的高黏度骨水泥PVP治疗胸腰椎OVCF均能减轻病人疼痛,改善脊柱功能,具有良好的临床疗效,单侧入路具有手术时间短、透视少的优点。

Objective To evaluate the clinical efficacy of unilateral and bilateral percutaneous vertebroplasty(PVP)combined with high viscosity bone cement in the treatment of thoracolumbar osteoporotic vertebral compression fractures(OVCFs).Methods From January 2017 to December 2020,83 patients with thoracolumbar OVCF underwent PVP in our hospital.According to the surgical method,they were divided into a unilateral group(43 cases)or a bilateral group(40 cases).The unilateral group underwent unilateral percutaneous vertebroplasty with high viscosity bone cement,and the bilateral group Bilateral percutaneous vertebroplasty with high viscosity bone cement was performed.Bone cement dispersion in the fractured vertebra was observed.The operation time,fluoroscopy frequency,injection volume of bone cement,compression degree of anterior vertebral body,Cobb angle of kyphosis,bone cement leakage rate,visual analogue scale(VAS)score and ODI(The Oswestry Disability Index)score were recorded.Results Among the 83 patients included,the operation time and frequency of fluoroscopy in the unilateral group were significantly lower than those in the bilateral group(P<0.05).The amount of bone cement injected in the bilateral group was significantly higher than that in the unilateral group(P<0.05).Compared with the baseline,the VAS scores and ODI scores of the two groups at 1 month and 6 months after operation were significantly decreased(P<0.05).There was no significant difference in the leakage rate of ground bone cement between the two groups(P>0.05).Conclusion Unilateral or bilateral high-viscosity bone cement PVP in the treatment of thoracolumbar OVCF can relieve pain and improve spinal function,and has a good clinical effect.Unilateral approach has the advantages of short operation time and less fluoroscopy.