单侧椎弓根外侧入路椎体成形术治疗骨质疏松性压缩骨折的临床研究

目的探讨单侧经椎弓根外侧入路在椎体成形术(percutaneous vertebroplasty,PVP)治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCFs)的特点与疗效。方法回顾性分析2010年1月～2012年1月我院收治的60例OVCFs患者(共85个椎体)的临床资料,均采用单侧椎弓根外侧入路行PVP术。受伤至手术时间平均5.7(3～31)d。术中观察穿刺针针尖达到椎体中线的比率、手术时间、出血量、骨水泥灌注量、骨水泥向椎体外渗漏率以及患者的满意度,比较术前、术后1 d及术后12月随访时视觉疼痛评分(visual analogue scales,VAS)、后凸角的改善率。结果 60例(85个椎体)均经单侧椎弓根外入路完成PVP操作。手术时间31～52 min,术中出血0～5 ml,骨水泥灌注量2.0～4.5 ml。骨水泥在椎体内分布对称,无穿刺并发症。5个椎体发生骨水泥渗漏,渗漏率5.9%。术后均获得随访,随访时间12个月。VAS评分术前平均为8.17±0.52,术后1 d平均为3.72±0.35,术后12月平均为2.21±0.25,三者比较,术前与术后1 d、术后12月时VAS评分差异均有统计学意义(P﹤0.05),疼痛均得到了明显改善;术前、术后1 d及术后12月时Cobb角分别为9.50°±3.19°、9.41°±3.08°、9.45°±2.83°,差异均无统计学意义(P﹥0.05),椎体高度无明显塌陷。患者满意率达100%。结论单侧椎弓根外穿刺入路行PVP术治疗胸腰椎OVCFs是一种安全、可行和有效的治疗方法。

Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures via Unilateral Extra-pedicle of Vertebral Arch Approach

Objective To explore the characteristics and effects of percutaneous vertebroplasty （PVP） for osteoporotic vertebral compression fractures （OVCFs） via unilateral extra-pedicle of vertebral arch ap- proach. Methods The clinical data of 60 cases （85 vertebras） with OVCFs admitted from January 2010 to January 2012 were analyzed retrospectively. All patients were performed the PVP via unilateral extra-pedicle of vertebral arch approach. The duration between injuries to surgery was 3 to 31 days with an average of 5.7 days. The operative time, blood loss, priming volume of bone cement, cement leakage rate and patient degree of sat- isfaction were observed. The visual analogue scales （VAS） and Cobb angle of preoperation, one day and 12 months after the operation were compared. Results A total of 60 patients （85 vertebras） with OVCFs were performed PVP via unilateral extra-pedicle of vertebral arch approach at prone position under local anesthesia with the help of fluoroscopic machines. The operative duration was 31 to 52 minutes, blood loss was 0 to 5 ml, and priming volume of bone cement was 2.0 to 4.5 ml. The bone cement was symmetrical distribution in the vertebrae and no severe complication of puncture was found. There were cement leakage in 5 vertebral bodies and the cement leakage rate was 5. 9%. All cases were followed up for 12 months. The VAS score was8.17 ± 0.52, 3.72 ± 0. 35 and 2.21 ± 0.25 respectively at pre-operation, 1 day after the operation and 12 months after the operation, and there was statistic difference between VAS of preoperation and that of 1 day after the operation or 12 months after the operation respectively （ P 〈 0.05 ）. The Cobb angle was 9.50 ° ± 3.19°, 9.41 ° ± 3.08 ° and 9.45°±2.83° respectively at pre-operation, 1 day after the operation and 12 months after the operation, and there was no statistic difference among them （ P 〉 0.05 ）. The patient＇s satisfaction rate was achieved 100.0%. Conclusion The procedure of PVP via unilateral extra-pedicle of vertebral arch approach is safe, feasible, and effective surgery interference for OVCFs.