不同入路椎体后凸成形术治疗骨质疏松性椎体压缩骨折

Kyphoplasty via different approaches for osteoporotic vertebral compression fractures

背景:骨质疏松性椎体压缩骨折是骨质疏松症最常见的并发症。经皮椎体后凸成形术是骨质疏松性椎体压缩骨折的有效治疗手段,其手术入路有经单侧、双侧椎弓根入路,两种手术入路存在各自优缺点。目的:探讨单侧、双侧椎弓根入路经皮穿刺椎体后凸成形术治疗骨质疏松性椎体压缩骨折的临床疗效及价值。方法:2014年3月至2020年4月期间收治胸腰椎骨质疏松性椎体压缩骨折患者383例,分别采用双侧椎弓根入路经皮穿刺椎体成形术治疗(双侧入路组208例)或单侧椎弓根入路经皮穿刺椎体成形术治疗(单侧入路组175例)。所有患者术前、术后随访均评估Oswestry功能障碍指数(ODI)、目测类比评分并行X射线片检查,测量并比较两组患者手术时间、出血量、骨水泥填充量、X射线照射次数、椎体后凸Cobb角度、伤椎椎体前缘高度、中间高度、骨水泥渗漏率及相邻椎体再骨折发生率。结果与结论:所有患者获得25-98个月(平均43.3个月)的随访。(1)单侧入路组手术时间、术中出血量、骨水泥注入量、术中X射线曝光次数均明显少于双侧入路组(P<0.05)。(2)单侧及双侧入路组组内目测类比评分、ODI功能指数、椎体后凸Cobb角度、椎体前缘高度及中间高度术前与术后1个月比较,差异有显著性意义(P<0.05),末次随访与术后1个月比较差异无显著性意义(P>0.05);末次随访时两组组间比较差异无显著性意义(P>0.05)。(3)骨水泥渗漏率单侧入路组与双侧入路组分别为7.7%(15例/194例)、8.1%(19例/234例),两组比较差异无显著性意义(P>0.05)。(4)术后相邻非手术椎体骨折发生率单侧与双侧入路组分别为9.1%(16例/175例)、6.3%(13例/208例),两组比较差异无显著性意义(P>0.05)。(5)结果说明,同传统双侧椎弓根入路相比,单侧椎弓根入路经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折临床疗效满意,同时还可有效缩短手术时间,减少术中出血量及骨水泥注入量,降低骨水泥渗漏风险。

BACKGROUND:Osteoporotic vertebral compression fracture is the most common complication of osteoporosis.Percutaneous kyphoplasty is an effective treatment for osteoporotic vertebral compression fractures.Its operative approaches include unilateral and bilateral pedicle approaches.The two approaches have their advantages and disadvantages.OBJECTIVE:To explore the clinical effect and value of the unipedicular and bipedicular approaches to percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fracture.METHODS:383 patients with osteoporotic vertebral compression fractures of the thoracic and lumbar spine were operated on from March 2014 to April 2020 via bipedicular approach(bipedicular group,208 cases)and unipedicular approach(unipedicular group,175 cases)percutaneous kyphoplasty.All patients were followed-up using the Oswestry dysfunction index,visual analog scale score and X-ray inspection preoperatively and postoperatively.The operation time,blood loss,amount of bone cement injected,frequency of X-ray exposure,Cobb angle of vertebral kyphosis,vertebral body leading edge height,intermediate height,cement leakage rate,and incidence of adjacent vertebral body re-fracture were measured and compared between the two groups.RESULTS AND CONCLUSION:All patients were followed up for 25-98 months(averaged 43.3 months).(1)Operation time,intraoperative blood loss,amount of bone cement injected,and intraoperative frequency of X-ray exposure were all significantly shorter in the unipedicular group than that in the bipedicular group(P<0.05).(2)Visual analog scale score,Oswestry dysfunction index,Cobb angle of vertebral kyphosis,vertebral leading edge height and intermediate height were statistically different preoperatively and 1 month postoperatively between the two groups(P<0.05),but there was no statistical difference between the last follow-up and 1 month postoperatively(P>0.05);no statistical difference was found between the two groups at the last follow-up(P>0.05).(3)The leakage rate of bone cement was 7.7%(15/194)in the unipedicular group and 8.1%(19/234)in the bipedicular group and no statistical difference was found between the two groups(P>0.05).(4)No statistical difference could be found in the incidence of adjacent non-surgical vertebral fractures in the unipedicular(9.1%,16/175)and bipedicular groups(6.3%,13/208)(P>0.05).(5)It is concluded that compared with the bipedicular approach to percutaneous kyphoplasty,the unipedicular approach for osteoporotic vertebral compression fracture has satisfactory clinical effects,can effectively reduce the operation time,intraoperative blood loss,bone cement injection volume and risk of bone cement leakage.