单侧入路椎体强化术治疗单节段骨质疏松性压缩性骨折2年随访

Unilateral approach vertebral augmentation for single segment of compression fracture-2 years follow up study

目的探讨单侧入路椎体强化术(包括经皮椎体成形术和经皮球囊扩张椎体后凸成形术)治疗骨质疏松性椎体压缩性骨折(Osteoporotic vertebral compression fractures,OVCFs)的长期效果。方法回顾我院自2007年1月~2011年10月应用单侧入路骨水泥充填椎体强化术治疗单节段椎体压缩性骨折共148例,所有患者均为骨质疏松性压缩性骨折。其中经皮椎体成形术(percutaneous vertebroplasty,PVP)64例,经皮球囊椎体后凸成形术(percutaneous Balloon Kyphoplasty,BKP)84例。随访分三个时间节点:术后2天,术后1个月,术后2年以上。前两个时间点使用视觉模拟评分(visual analogue scale,VAS)来评估近期治疗效果,术后2年使用Barthel指数及SF-36表来评估远期效果。结果 128例患者术后1个月内有效随访,89例患者术后2年仍有效随访,59例失访,9例死亡。未发现脊髓损伤及有症状的肺动脉栓塞,术中发生骨水泥渗漏23例,总渗漏率为15.5%。所有接受椎体强化术患者术前术后VAS评分差异有统计学意义(<0.01)。BKP组与PVP组VAS评分及术后2年Barthel指数和SF-36表评分比较差异无统计学差异(>0.05)。结论单侧入路骨水泥充填椎体强化术治疗单节段骨质疏松性椎体压缩性骨折,PVP以及BKP技术均可以取得很好的短期及长期临床效果,PVP和BKP的短期疗效和2年以上的长期效果之间无差异。

Objective To investigate the long-term effect of unilateral approach vertebral augmentation(including percutaneous vertebroplasty and percutaneous kyphoplasty) in the treatment of osteoporotic vertebral compression fractures(OVCFs). Methods 148 cases with single segment of vertebral compression fractures treated in our hospital from January2007 to October 2011 using unilateral approach bone cement vertebroplasty were analysed retrospectively. 64 cases were treated with percutaneous vertebroplasty(PVP) and 84 cases were treated with percutaneous balloon kyphoplasty(BKP).Respectively recorded the scores of visual analogue scale(VAS) at three time points: the preoperative time, the second postoperative day and the first postoperative month. Recorded the Barthel index and SF-36 scores 2 years postoperatively.Results 128 cases followed up 1 month and 89 cases followed up 2 years postoperatively, 59 cases missed, 9 patients passed away. No spinal cord injury and symptomatic pulmonary embolism, 23 cases of bone cement leakage occurred during operation procedures, the total rate of leakage is 15.5%. There are statistical significant VAS score differences between the preoperative and postoperative time points( <0.01) and no significant difference between the BKP group and PVP group( >0.05). Respectively there are no differences in the Barthel index and SF-36 score between the two groups in the 2 postoperative years( >0.05). Conclusion For the treatment of single segment osteoporotic vertebral compression fracture, both PVP and BKP with unilateral approach of bone cement filling vertebral augmentation have not only shortterm but also long-term clinical effects, there are no differences between PVP and BKP.