单、双侧入路经皮椎体后凸成形术治疗骨质疏松性、肿瘤性椎体新鲜性压缩骨折的疗效比较

目的 探讨经皮椎体后凸成形术(PKP)单侧与双侧椎弓根入路治疗椎体新鲜性压缩骨折的效果.方法 共78例96节骨质疏松性、肿瘤性椎体新鲜性压缩性骨折患者,其中单侧经椎弓根入路单球囊58例69节椎体,双侧经椎弓根入路20例27节椎体,其中肿瘤病椎2例4节椎体,采用单球囊或双球囊扩张器行椎体后凸成形术.术前、术后2周、2年进行疼痛视觉类比评分(VAS)、测量椎体高度恢复率、后凸Cobb角.结果 经2周～2年随访,单侧组及双侧组术后2周及术后2年疼痛视觉类比评分(VAS)、后凸Cobb角较术前均减少(P＜0.05).术后2周、后2年后凸Cobb角恢复率单侧组分别为51.2％、44.5％;双侧组为53.2％、47.8％.术后2周、2年椎高恢复率单侧组分别为47.2％、44.5％;双侧组分别为51.3％、47.2％.术后2周、2年VAS评分、后凸Cobb角及椎高恢复率两组比较差异无统计学意义(P＞0.05),VAS评分术后2年较术后2周骨折均能恢复伤椎体高度、纠正后凸Cobb角并缓解疼痛.术后针对骨质疏松症、肿瘤的病因治疗可提高疗效.结论 采用单侧与双侧经椎弓根入路经皮椎体后凸成形术治疗骨质疏松性、肿瘤性椎体新鲜性压缩性骨折均能恢复伤椎体高度、纠正后凸Cobb角并缓解疼痛.     

单侧与双侧经皮球囊扩张椎体成形术治疗骨质疏松性椎体压缩性骨折的疗效分析

【摘要】 目的 比较双侧与单侧经皮球囊扩张椎体成形术(PKP)治疗骨质疏松性椎体压缩性骨折的疗效。方法〓对32例骨质疏松性单节段椎体压缩性骨折进行PKP,其中单侧入路16例,双侧入路16例。观察2组手术时间、手术过程、术后即刻、术后1个月及术后3个月的并发症发生率、脊柱后凸Cobb角、视觉模拟疼痛评分(VAS)及日常生活能力评分(ADL)的差异。结果〓单侧入路组与双侧入路组手术时间分别为40.1±10.0 min、55.3±12.6 min,两者差异有统计学意义(t=-3.780,P<0.001)。术后随访6个月,未发生骨水泥侧漏至椎体两侧、椎间盘、椎管、椎体周围静脉丛,未出现患者神经症状加重、瘫痪等临床并发症。术后6个月,单侧入路组脊柱后凸Cobb角为4.8±0.5°、显著小于双侧组8.3±0.8°(t=-14.840,P<0.001),且分别与治疗前相比,差异均有统计学意义;单侧入路组与双侧入路组VAS评分分别为2.2±0.3分、2.4±0.3分,两者间差异无统计学差异(t=-1.886,P=0.069),与术前比较均有统计学意义。单侧入路组与双侧入路组ADL评分分别为87.6±2.7分、88.0±3.8分,两者间差异无统计学差异(t=-0.343,P=0.734)。术后6个月,单侧组与双侧组椎体中部高度分别为17.6±1.5 mm、8.0±1.7 mm,与治疗前相比,差异有统计学意义(t=-0.706,P=0.486)。结论〓单侧与双侧入路PKP对骨质疏松性椎体压缩性骨折均具有快速缓解疼痛、恢复椎体高度、矫正脊柱后凸畸形等优点;双侧入路在维持矫正椎体后凸畸形方面更有优势,但单侧入路手术时间短,操作过程简单,手术费用少。     

经皮椎体后凸成形术单侧与双侧椎弓根入路治疗骨质疏松性椎体压缩骨折效果比较

目的比较经皮椎体后凸成形术(PKP)单侧与双侧椎弓根入路治疗骨质疏松性椎体压缩骨折的效果。方法选择2010年1月~2014年5月于浙江省金华市中医院住院并行手术治疗的骨质疏松性椎体压缩骨折患者68例。采用随机数字表将其分为单侧组(34例,41个椎体)和双侧组(34例,42个椎体),分别采用单侧与双侧椎弓根入路进行PKP治疗。观察并比较两组患者手术时间、出血量和骨水泥灌注量及术后椎体压缩率、Cobb’s角恢复情况、疼痛缓解情况及并发症的发生率。结果单侧组患者的手术时间、出血量和骨水泥灌注量[(46.64±9.71)min、(5.14±1.42)m L、(3.24±0.72)m L]均明显少于双侧组[(64.27±12.71)min、(7.29±1.78)m L、(4.38±0.94)m L],差异有统计学意义(t=2.32、2.37、2.29,P<0.05);术后1个月,两组患者椎体压缩率、Cobb’s角和VAS评分[(22.84±4.43)%、(15.31±3.07)°、(2.72±0.49)分、(21.73±4.12)%、(14.87±2.95)°、(2.60±0.45)分]均较术前[(35.82±6.48)%、(24.26±5.17)°、(8.16±1.37)分、(36.07±7.05)%、(23.92±4.97)°、(7.92±4.97)分]明显改善,差异有统计学意义(t=2.31、2.34、4.07、2.41、2.37、4.15,P<0.05或P<0.01),且两组患者改善幅度比较差异无统计学意义(P>0.05);两组患者术中均未发生神经及脊髓损伤,单侧组和双侧组术后发生骨水泥渗漏5例和3例,两组患者术后并发症发生率比较差异无统计学意义(χ2=0.14,P>0.05)。结论单侧与双侧椎弓根入路PKP均是治疗骨质疏松性椎体压缩骨折安全有效的微创方法 ,两者在缓解腰背部疼痛、恢复椎体高度及Cobb’s角上的疗效相当,前者的手术创伤小、手术时间短、出血量少和骨水泥灌注量相对较少,不增加术后并发症的发生率。     

经单、双侧椎弓根入路椎体成形术渗漏比较研究

目的：对离体椎体经单侧和双侧椎弓根入路的两种椎体成形方法引发的椎体外骨水泥渗漏进行比较研究。方法：采集尸体的腰椎（L1-L5）共40个,在前屈压缩载荷下造成椎体骨折。然后随机分成两组,A组经单侧椎弓根注入椎体4ml PMMA;B组经双侧椎弓根灌注4ml PMMA（每侧2ml）。注射过程中观察有无骨水泥渗漏发生,按部位计数渗漏的椎体并计算渗漏率。结果：A组有11个椎体发生渗漏,经终板渗漏11个、椎体前侧缘4个、椎体后缘3个、穿刺道渗漏6个、混合渗漏6个（2例椎体前侧缘＋穿刺通道,4例终板＋椎体前侧缘）,渗漏率为41.25%。B组有12个椎体发生渗漏,经终板3个、椎体前侧缘4个、椎体后缘3个、经穿刺道渗漏12个、混合渗漏4个（2例终板＋穿刺道,2例椎体前侧缘＋穿刺通道）,渗漏率为27.5%。两组渗漏率差异有统计学意义。结论：双侧椎弓根入路椎体成形骨水泥渗漏少于单侧,有统计学意义。     

Kyphoplasty for chronic painful osteoporotic vertebral compression fractures via unipedicular versus bipedicular approachment: A comparative study in early stage

Background

Osteoporotic compression fractures (OVCFs) commonly occur in aged people, and as much as one-third of these fractures progress to chronic pain. Kyphoplasty (KP) is proved to be efficacious for pain relief and vertebral height restoration in chronic OVCFs, but there is still no data available about the clinical and radiographical outcomes compared by unipedicular and bipedicular KP in treating chronic painful OVCFs.

Purpose

To assess the clinical and radiographical outcomes in treating chronic painful OVCFs compared by unipedicular and bipedicular KP.

Methods

Fifty-eight patients with a total of sixty-six chronic painful OVCFs were enroled in our study. They were randomly allocated into two groups: group I (n = 33) was treated with unipedicular KP and group II (n = 25) with bipedicular KP. The operation times for each group were recorded and compared. Preoperative and postoperative of visual analogue scores (VAS) and oswestry disability index (ODI) scores were compared 2 weeks after surgery within each group and between groups. The radiographic outcomes were evaluated by the restoration rate (RR) in the most compressed point of the vertebral bodies.

Results

Significant improvement on the VAS, ODI scores and RR was noted in each group (p < 0.001), and there is no significant difference existing in clinical outcomes between the two groups. The mean operation time for each vertebra in group I was significantly shorter than in group II (p < 0.001). But the RR in group II was higher than in group I (p = 0.041).

Conclusion

Both unipedicular kyphoplasty and bipedicular kyphoplasty can achieve satisfactory clinical and radiographic outcomes in treating the chronic painful OVCFs and the operation time is shorter in unipedicular kyphoplasty. However, the bipedicular kyphoplasty is more efficacious in height restoration.