双侧矢状面交叉经皮椎体后凸成形术预防手术椎体再骨折

Efficacy of bilateral sagittal cross percutaneous kyphoplasty for preventing recurrent fracture of the cemented vertebrae

目的:探讨双侧矢状面交叉经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)预防手术椎体再骨折的疗效。方法:2017年1月至2017年6月,应用双侧矢状面交叉PKP治疗单节段骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCFs)患者85例(交叉组),男35例,女50例,年龄(70.1±8.3)岁;同期应用传统PKP治疗85例单节段OVCFs患者(传统组),男37例,女48例,年龄(73.3±9.5)岁。观察两组患者术后椎体内骨水泥分布情况,手术椎体再骨折的发生情况,伤椎前缘高度及矢状面Cobb角,疼痛视觉模拟评分(visual analogue scale,VAS)。结果:所有手术顺利完成,两组患者均获得随访,随访时间交叉组(11.8±4.5)个月,传统组(12.1±3.7)个月。交叉组所有患者骨水泥分布同时接触椎体的上下终板,传统组有67例(78.8%)骨水泥分布同时接触椎体的上下终板,两组差异有统计学意义(P<0.05)。交叉组患者未发生手术椎体再骨折,传统组有10例(11.8%)发生手术椎体再骨折,两组差异有统计学意义(P<0.05)。两组患者术后2 d的伤椎前缘高度、矢状面Cobb角和腰痛VAS评分与术前相比均得到明显改善(P<0.05);两组末次随访时的骨折椎前缘高度、矢状面Cobb角和腰痛VAS评分与术后2 d比较差异均无统计学意义(P>0.05)。结论:双侧矢状面交叉PKP可以使骨水泥在骨折椎体内分布同时接触椎体的上下终板,从而预防PKP术后手术椎体再骨折的发生,是一项简单、安全、有效的技术。

Objective:To explore the efficacy of bilateral sagittal cross percutaneous kyphoplasty(PKP)for preventing recurrent fracture of the cemented vertebrae.Methods:From January 2017 to June 2017,85 patients with single-segment osteoporotic vertebral compression fractures(OVCFs)were treated by bilateral sagittal cross PKP(cross group).There were 35 males and 50 females with an average age of(70.1±8.3)years old in cross group.Another 85 patients with single-segment OVCFs were treated by traditional PKP(traditional group).There were 37 males and 48 females with an average age of(73.3±9.5)years old in traditional group.The cement distribution condition,recurrent fracture of the cemented vertebrae,the anterior vertebral body height and sagittal Cobb angle,visual analogue scale(VAS)were observed in two groups.Results:All patients underwent operation successfully.The follow-up time were(11.8±4.5)months in cross group and(12.1±3.7)months in traditional group.In cross group,all patients’bone cement touched the upper and lower endplates of the vertebral body while 67 cases(78.8%)in traditional group did with significant difference between two groups(P<0.05).No patient in cross group suffered recurrent fracture of the cemented vertebrae while 10 cases(11.8%)in traditional group did with significant difference between two groups(P<0.05).The anterior vertebral body height,sagittal Cobb angle and VAS in both groups were obvious improved at 2 days after operation(P<0.05)and there were no significant difference between two groups at 2 days after operation and the final follow-up(P>0.05).Conclusion:Bilateral sagittal cross PKP was a simple,safe and effective technique which can make bone cement distribute in the fractured vertebral body and contact the upper and lower endplates of the vertebral body,thus preventing the recurrent fracture of the cemented vertebrae.