单侧和双侧经皮椎体成形术治疗骨质疏松性椎体压缩骨折的疗效对比

Comparison of unilateral and bilateral percutaneous vertebroplasty for treatment of osteoporotic vertebral compression fracture

目的本研究旨在调查和评价单侧和双侧经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)的临床结果和并发症。方法选取2019年6月至2022年6月在河南省骨科医院行PVP治疗OVCF的127名患者的临床资料。根据穿刺入路的不同分为:单侧椎体成形组(unilateral vertebroplasty,UVP)68例,双侧椎体成形组(bilateral vertebroplasty,BVP)59例。于术前,术后1天,术后1年时采用Oswestry功能障碍指数(Oswestry disability index,ODI)评分,疼痛视觉模拟量表(pain visual analogue scale,VAS)评估临床效果;通过X线测量伤椎椎体高度和楔形角变化。记录两组患者的住院时间,手术时间,住院花费,术中放射次数,骨水泥注射量及并发症发生的情况。结果(1)重复测量方差分析结果表明两组患者ODI和VAS评分仅在时间效应上存在统计学差异(P<0.05),伤椎椎体高度和楔形角在组间效应、时间效应和交互效应上均存在统计学差异(P<0.05)。(2)与双侧PVP相比,单侧PVP手术时间短,住院花费小,放射次数少,差异有统计学意义(P<0.05)。(3)并发症方面,两组患者水泥渗漏率和伤椎再骨折率存在统计学差异(P<0.05)。结论两种穿刺入路均可提供良好的疼痛缓解和生活质量改善。双侧PVP对伤椎椎体高度和楔形角的维持更稳定,能够减少伤椎再骨折。单侧PVP在手术时间、住院花费、放射次数和水泥注射量方面具有明显优势。

Objective This study aimed to investigate and evaluate the clinical outcomes and complications of unilateral and bilateral percutaneous vertebroplasty(PVP)for the treatment of osteoporotic vertebral compression fracture(OVCF).Methods The clinical data of 127 patients with OVCF who underwent PVP in our hospital from June 2019 to June 2022 were selected.According to the different puncture approaches,the patients were divided into unilateral vertebroplasty group(UVP,68 cases)and bilateral vertebroplasty group(BVP,59 cases).Oswestry disability index(ODI)and Pain visual analogue scale(VAS)were used to evaluate the clinical effect before operation,1 day after operation and 1 year after operation.The changes of vertebral height and wedge angle were measured by X-ray.The hospitalization time,operation time,hospitalization cost,intraoperative radiation times,bone cement injection volume and complications of the two groups were recorded.Results(1)The results of repeated measurement analysis of variance showed that the ODI and VAS scores of the two groups were statistically different only in the time effect(P<0.05),and the vertebral height and wedge angle of the injured vertebra were statistically different in the intergroup effect,time effect and interaction effect(P<0.05).(2)Compared with bilateral PVP,unilateral PVP had shorter operation time,less hospitalization cost and less radiation frequency,and the difference was statistically significant(P<0.05).(3)In terms of complications,there were statistical differences in cement leakage rate and refracture rate of injured vertebra between the two groups(P<0.05).Conclusion Both puncture approaches provide good pain relief and quality of life improvement.Bilateral PVP was more stable in maintaining the height and wedge angle of the injured vertebra and could reduce the refracture of the injured vertebra.Unilateral PVP has obvious advantages in terms of operation time,hospitalization cost,radiation frequency and cement injection volume.