经皮椎体后凸成形术治疗骨质疏松性胸腰椎压缩性骨折的临床研究

目的探讨经单侧或双侧椎弓根途径行椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩骨折的临床效果。方法 2009年9月至2012年9月安徽省立医院采用PKP治疗骨质疏松性胸腰椎压缩性骨折68例(80个椎体),按术中经单侧或双侧椎弓根途径进行分组。单侧进针组为单侧骨水泥注射过椎体中线者30例共34个椎体,男11例、女19例,单椎体26例,两椎体4例;双侧进针组38例共46个椎体,男7例、女31例,单椎体32例,双椎体4例,三椎体2例。采用视觉模拟评分(VAS)、Oswestry功能障碍指数评分(ODI)、伤椎前中部高度平均变化及后凸畸形Cobb角等指标分析手术疗效。结果单、双侧两组患者术后VAS评分及ODI评分结果较术前明显降低(P<0.05),组间比较差异有统计学意义(P<0.05);两组椎体平均高度及Cobbs角变化较术前均有显著恢复(P<0.05),组间比较差异有统计学意义(P<0.05)。术后3例发生周围椎体再骨折,单侧进针组1例,双侧进针组2例;共9例发生骨水泥渗漏,单侧进针组3例,双侧进针组6例,单、双侧两组骨水泥渗漏率比较差异无统计学意义(P>0.05);两组患者均未出现神经系统症状。结论 PKP经双侧椎弓根途径治疗骨质疏松性椎体压缩骨折较单侧在短期内能更好地缓解疼痛及功能障碍,能长期且更好地恢复伤椎高度及后凸畸形,而单、双侧两组在骨水泥渗漏方面无明显差异。

Clinical Research of Percutaneous Kyphoplasty Treatment of Osteoporotic Thoracolumbar Compression Fracture

Objective To investigate the effect of using the unilateral or bilateral pedicle way for percutaneous kyphoplasty(PKP) to treat osteoporotic vertebral compression fractures.Methods From September 2009 to September 2012 in Anhui Provincial Hospital 68 cases(80 vertebral body) used PKP for osteoporotic compression fractures,which were grouped according to the operation in unilateral or bilateral pedicle way.Unilateral group refers to unilateral bone cement shot over vertebral body neutral line,30 cases 34 vertebral bodies,male 11 cases,female 19 cases,single vertebral 26 cases,double-vertebral body 4 cases.Double side group and a total of 38 cases,46 vertebral bodies,male 7 cases,female 31 cases,single vertebral body 32 cases,double-vertebral body 4 cases,three-vertebral body 2 cases.Visual analogue scale(VAS),Oswestry dysfunction index score(ODI),and the central height average change before wound and protrusion deformity kyphosis Cobbs angle and so on iwere used to analyze operation curative effect.Results Single and double side two groups of patients: postoperative VAS scores and ODI were improved significantly(P < 0.05),the difference between the two groups was statistically significant(P < 0.05);vertebral body height and average Cobbs angle of the two groups were improved significantly(P < 0.05),difference between the two groups was statistically significant(P < 0.05);3 cases had surrounding vertebral body fracture again,1 case in unilateral group,2 cases in double side group.9 cases had bone cement leakage,3 cases in unilateral group,6 cases in double side group,bone cement leakage rate difference of the two groups was not statistically significant(P > 0.05).No nervous system symptoms were found in either group.Conclusion The bilateral pedicle way puncture treatment of osteoporotic vertebral compression fractures is better than unilateral in pain and functional disorder relief in the short term,in the long run,it can better recover injured vertebral height and convex deformity,and no obvious difference is observed in bone cement leakage between the bilateral and unilateral group.