单、双侧经皮椎体成形术治疗骨质疏松性椎体压缩骨折

目的探讨经单、双侧椎弓根途径行经皮椎体成形术治疗骨质疏松性椎体压缩骨折的临床疗效。方法回顾分析2009年2月至2011年2月在我院行经皮椎体成形术治疗的47例骨质疏松性椎体压缩骨折患者的临床资料。随机分成两组，分别采用单侧或双侧椎弓根途径行经皮椎体成形术。单侧组25例51个椎体（T11 11个、T12 16个、L1 15个、L2 9个），男10例，女15例，年龄56～77岁，平均66．9岁。双侧组22例45个椎体（T11 10个、T12 13个、L1 13个、L2 9个），男8例，女14例，年龄57～80岁，平均68．7岁。随访1年，观察患者手术前后VAS评分、SF．36评分、椎体平均高度变化及骨水泥渗漏。结果所有病例均顺利完成，无肺栓塞、神经根损伤等严重并发症。单侧穿刺组每个椎体的手术时间为27～46min，平均36min。每个椎体骨水泥注入量为3—5mL，平均3．8mL。双侧穿刺组每个椎体的手术时间为48～89min，平均69min。每个椎体骨水泥注入量为4～7mL，平均5．9mL。单侧穿刺组51个椎体中10个椎体发生骨水泥渗漏（19．6％），双侧穿刺组45个椎体中17个椎体发生骨水泥渗漏（37．8％），两组骨水泥渗漏差异有统计学意义（P〈0．05）。术前两组VAS评分、SF-36评分无统计学意义，术后3d及术后1年两组VAS评分、sF一36评分均较术前明显改善（P〈0．05），但两组间比较无统计学意义。两组手术前后椎体平均高度均无明显变化。结论单、双侧经皮椎体成形术治疗骨质疏松性椎体压缩骨折均可取得同样满意的临床效果，但单侧经皮椎体成形术在手术时间、安全性上更具优势，更适合在广大基层医院推广普及。

Outcomes of Unilateral or Bilateral Percutaneous Vertebroplasty for Osteoporotic Vertebral Com- pression Fractures

Objective To compare the clinical outcomes of unilateral versus bilateral percutaneous vertebroplasty for osteoporotic compression fracture. Methods 47 cases （96 vertebrae） with osteoporotic vertebral compression fracture and underwent percutaneous vertebroplasty from February 2009 to February 2011 were reviewed retrospectively. All cases were randomly divided into two groups according to unilateral or bilateral approach. The unilateral group （25 patients, 51 vertebraes） included 10 males and 15 females with an average age of 66.9 （range ,56 - 77 years old） , while 22 patients （45 vertebraes） were in the bipedicular group, inciuding 8 males and 14 females with an average age of 68.7 （range,57 - 80 years old）. The visual analogue scale（VAS）, SF-36 scale, average vertebral body height at pre and post-operation and incidence of complications were used to observe the difference between 2 groups. Results All patients underwent surgery successfully. The unilateral group had an average operative time of 36 min（ range ,27 - 46 min） and an average of bone cement filling of 3.8 mL（ range, 3-5 mL）,while those for bilateral group were 69 min（range,48- 89 min） and of 5.9 mL（range,4-7 mL） respectively. The VAS score and SF-36 scale decreased significantly after operation（ P 〈 0.05 ） , but no significant difference were noted between 2 groups （P 〉 0.05 ）. The rate of cement leakage, unilateral group was 19.6% and bilateral group was 37.8% , significant difference were observed between 2 groups （ P 〈 0.05 ）. Both groups had no significant change for average vertebral height（ P 〉 0.05 ）. Conclusion Both unilateral and bilateral percutaneous vertebroplasty are reliable for OVCFs, but unipedicular approach has the advantages of shorter operation time and lower bone cement leakage rate.