椎体成型单侧与双侧穿刺经皮椎体后凸成形术治疗骨质疏松压缩性骨折的疗效观察

目的探讨椎体成型单侧与双侧穿刺经皮椎体后凸成形术(PKP)治疗骨质疏松压缩性骨折(OVCF)的疗效。方法前瞻性选取2016年8月至2019年9月芜湖市第二人民医院收治的OVCF患者80例为研究对象。采用随机数字表法将患者分为双侧组(n=40)与单侧组(n=40)。双侧组采取双侧椎弓根穿刺,单侧组采取单侧椎弓根穿刺。观察2组患者术中情况、Cobb角、伤椎体前缘高度、伤椎体中线高度和并发症及再骨折发生率。结果单侧组手术时间、术中透视次数、术中出血量及平均每椎骨水泥注入分别为(42.76±9.57)min、(16.24±3.42)次、(7.08±1.91)mL、(4.03±0.49)mL,均低于双侧组(63.81±11.27)min、(27.63±6.07)次、(11.24±1.44)mL、(5.91±0.72)mL],差异均有统计学意义(P<0.05)。术后3 d及术后6个月,单侧组与双侧组Cobb角(11.83±1.52)°、(12.11±1.42)°,(12.24±1.67)°、(12.49±1.57)°]均较术前降低,伤椎体前缘高度(24.11±1.28)、(22.46±0.81)mm,(24.12±1.29)、(22.51±0.83)mm]及伤椎体中线高度(24.57±1.49)、(24.18±1.21)mm,(24.81±1.55)、(24.15±1.19)mm]均较术前升高(P<0.05)。2组患者术前、术后3 d及术后6个月Cobb角、伤椎体前缘高度及伤椎体中线高度比较,差异均无统计学意义(P>0.05)。单侧组骨水泥泄露率(5.00%)与双侧组(10.00%)比较,差异无统计学意义(P>0.05);术后随访1年,发现单侧组再骨折率(2.50%)低于双侧组(17.50%),差异有统计学意义(P<0.05)。结论单、双侧穿刺入路PKP治疗OVCF临床疗效相当,但实践中应尽量先行单侧穿刺入路PKP,操作简单且骨水泥用量少,再骨折率更低,若骨水泥分布不均手术难度较大时可进行双侧穿刺入路PKP。

Efficacy of unilateral puncture and double puncture PKP with vertebroplasty in the treatment of osteoporotic compression fractures

Objective To investigate the efficacy ofvertebroplasty unilateral and double puncture percutaneous kyphoplasty(PKP)in the treatment of osteoporotic vertebral compression fractures(OVCF).Methods Eighty patients with osteoporotic compression fractures admitted to the Second People's Hospital of Wuhu City from August 2016 to September 2019 were selected and randomly divide into bilateral group(n=40)and unilateral group(n=40).The bilateral group received bilateral pedicle puncture,and the unilateral group received unilateral pedicle puncture.The intraoperative conditions,the Cobb angle,the height of the anterior edge in the injured vertebral body,the height of the midline in the injured vertebral body and the incidence of complications and re-fractures were observed in the two groups.Results The operation time,the number of intraoperative fluoroscopy,intraoperative blood loss and average cement injection per vertebra in the unilateral group were(42.76±9.57)min,(16.24±3.42)times,(7.08±1.91)mL,(4.03±0.49)mL,respectively,lower than those in the bilateral group(63.81±11.27)min,(27.63±6.07)times,(11.24±1.44)mL,(5.91±0.72)mL],the differences were statistically significant(P<0.05).Three days after operation and 6 months after operation,Cobb angles of unilateral group and bilateral group(11.83±1.52)°,(12.11±1.42)°,(12.24±1.67)°,(12.49±1.57)°]were lower than before operation,the height of the front edge of the injured vertebral body(24.11±1.28),(22.46±0.81),(24.12±1.29),(22.51±0.83)mm]and the height of the midline of the injured vertebral body of unilateral group and bilateral group(24.57±1.49),(24.18±1.21),(24.81±1.55),(24.15±1.19)mm]were all higher than those before operation(P<0.05).There was no significant difference in the Cobb angle,the height of the anterior edge of the injured vertebral body,and the midline height of the injured vertebral body before operation,3 days after operation and 6 months after operation between the two groups(P>0.05).There was no significant difference in the bone cement leakage rate(5.00%)between the unilateral group and the bilateral group(10.00%)(P>0.05).After a 1-year follow-up,it was found that the re-fracture rate of the unilateral group(2.50%)was lower than that of the bilateral group(17.50%),and the difference was statistically significant(P<0.05).Conclusion The clinical efficacy of unilateral and bilateral puncture approach PKP are equivalent in the treatment of OVCF.In practice,however,unilateral puncture approach PKP should be performed first in thatthe operation is simple,the amount of bone cement is small,and the fracture rate is lower.If the bone cement is not distributed and the operation is difficult,PKP can be performed bilaterally.