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单侧与双侧经皮椎体后凸成形术治疗老年骨质疏松性椎体压缩骨折的疗效 被引量:34

Unilateral versus bilateral percutaneous kyphoplasty for elderly patients with osteoporotic vertebral compression fractures
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摘要 目的比较单侧与双侧椎弓根入路经皮椎体后凸成形术(PKP)治疗老年新鲜骨质疏松性椎体压缩骨折(OVCF)的临床疗效。方法回顾性分析2014年1月至2017年6月接受PKP治疗的134例胸腰椎单椎体OVCF患者的临床资料,按手术入路将患者分为单侧组(经单侧椎弓根入路)和双侧组(经双侧椎弓根入路)。观察患者术后椎体高度恢复率、后凸角改善情况、疼痛改善情况,以及术中骨水泥注入量和骨水泥渗漏情况等。结果单侧组61例,平均年龄(74.7±9.6)岁,双侧组73例,平均年龄(75.1±8.6)岁。两组患者术后伤椎椎体前缘和中间高度的丢失率以及后凸角均较术前减小(P<0.05)。Ⅰ°骨折患者,术后伤椎的椎体前缘和中间高度恢复率、后凸角恢复率两组比较无差异(P>0.05),单侧组术后骨水泥侧漏少于双侧组(P<0.05)。Ⅱ°/Ⅲ°骨折患者,术后伤椎的椎体前缘和中间高度恢复率、后凸角恢复率双侧组均优于单侧组(P<0.05),两组骨水泥侧漏情况无差异(P>0.05)。与术前相比,两组患者术后3d和末次随访时的VAS均明显降低(P<0.05),但两组间术后3d及末次随访的VAS比较无差异(P>0.05)。结论单椎体OVCF骨折患者,如果为Ⅰ°骨折或一侧椎弓根破坏严重、进针困难时宜选择单侧入路PKP手术,Ⅱ°或Ⅲ°骨折时宜选择灌注高黏度骨水泥的双侧入路PKP手术。 Objective To investigate the clinical efficacy of unilateral versus bilateral approach percutaneous kyphoplasty(PKP)in the treatment of elderly patients with osteoporotic vertebral compression fractures(OVCF).Methods A total of 134 patients with single osteoporotic thoracolumbar vertebral compression fracture undergoing percutaneous kyphoplasty from January 2014 to June 2017 were reviewed retrospectively.All these patients were divided into two groups according to the unilateral or bilateral approach.The postoperative recovery rate of vertebral height,improvement of kyphosis angle and pain,and the amount of bone cement injection and leakage of bone cement during operation were compared between the two groups.Results There were 61 patients in the unilateral group with an average age of 74.7 ± 9.6 years,and 73 patients in the bilateral group with an average age of 75.1±8.6 years.The loss rate of anterior and middle vertebral height,and kyphosis angle of vertebral body in both groups after operation were smaller than those before operation(P〈0.05).In terms of the recovery rate of anterior and middle vertebral height and the kyphosis angle inⅠ°fractures,the difference between the two groups was not statistically significant(P〉0.05).But the leakage of bone cement in the unilateral group was less severe than the bilateral group(P〈0.05).For theⅡ°andⅢ°fractures,the recovery rate of anterior and middle vertebral height and the kyphosis angle in the bilateral group were significantly better than the unilateral group(P〈0.05),but no statistically significant difference was observed in the leakage of bone cement between the two groups(P〈0.05).The visual analogue score(VAS),grades on postoperative day 3 and latest follow up were significantly lower than the preoperative baseline in both groups(P〈0.05);but no significant difference was noted between the two groups after operation(P〉0.05).Conclusion It is suggested to choose unilateral approach PKP for Ⅰ°single vertebral fractures,or fractures in which one side of vertebral pedicle was damaged too seriously to insert a needle safely,whereas the bilateral approach with high viscosity bone cements is advised forⅡ°andⅢ°fractures.
作者 顾越 李威霖 贾根 刘军 GU Yue,LI Weilin,JIA Gen;LIU Jun(Department of Orthopedics,the Second Affiliated Hospital of Nanjing Medical University,Nanjing 210011,Chin)
出处 《国际骨科学杂志》 2018年第3期154-158,共5页 International Journal of Orthopaedics
关键词 骨质疏松 椎体压缩性骨折 经皮椎体后凸成形术 单侧入路 双侧入路 Osteoporosis Vertebral compression fractures Percutaneous kyphoplasty Unilateral approach Bilateral approach
作者简介 通信作者:刘军,Email:13776698080@139.com
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