单双侧穿刺椎体成形术对邻近椎体再骨折影响的比较

目的探讨单侧与双侧穿刺椎体成形术对邻近椎体再骨折的影响。方法统计分析2013年2月至2016年2月因骨质疏松性椎体压缩性骨折(osteoporotic vertebral compression fractures, OVCF)在我院进行经皮椎体成形术(percutanceous vertebroplasty,PVP)的80例患者术后邻近椎体再发骨折的情况,其中45例采用单侧穿刺,35例采用双侧穿刺,比较两种方法术后再发骨折率是否相同,并对比两种方法在骨水泥注入量、骨水泥椎间盘渗漏率、骨水泥分布情况、椎体高度恢复情况及Cobb角纠正情况、手术时间、X线曝光次数方面的差异性。结果单侧穿刺椎体成形术后再骨折率为24.4%,双侧穿刺椎体成形术后再骨折率25.7%,两种方法术后再骨折的发生率差别无统计学意义(P0.05),双侧穿刺的骨水泥注入量、手术时间、X线曝光次数明显多于单侧穿刺,差异有统计学意义(P0.05);双侧穿刺的骨水泥分布情况明显优于单侧穿刺,差异有统计学意义(P0.05);单侧穿刺与双侧穿刺在骨水泥椎间盘渗漏率、椎体高度恢复情况及Cobb角纠正情况无明显区别,差异无统计学意义(P0.05)。结论单侧穿刺椎体成形术与双侧穿刺椎体成形术术后邻近椎体再骨折率无明显差异,但由于单侧穿刺所需手术时间短,病人所承受的痛苦以及接受的辐射少,手术方法相对简单,因此一般情况下优先考虑单侧穿刺,若术中出现分布不均匀建议改为双侧穿刺。

Comparison the effects of adjacent vertebral re-fracture after unilateral and bilateral percutaneous vertebroplasty

Objective To investigate the effects of unilateral and bilateral percutaneous vertebroplasty on the adjacent vertebral re-fracture. Methods Statistical analysis the situation of adjacent vertebral re-fracture after the operation of 80 patients who suffered osteoporotic vertebral compression fractures and treated with PVP from Feb 2013 to Feb 2016 in our hospital, 80 patients were divided into two groups, 45 patients with unilateral punctures, 35 patients with bilateral punctures, compared the re-fracture rate of two methods. And compared the differences of two methods in bone cement injection volume, intervertebral disc leakage rate, distribution status and vertebral height recovery, Cobb angle correction, operation time, X-ray exposure times. Results Postoperative re-fracture rate of unilateral PVP was 24.4% and the bilateral puncture PVP was 25.7%, the re-fracture rate of two methods postoperative had no statistically significant(P>0.05), the injection volume, operation time and X-ray exposure times of bilateral puncture were significantly more than unilateral puncture, which had significant difference(P<0.05). There was a significant difference in bone cement distribution status (P<0.05). There were no difference in intervetebral disc leakage rate, vertebral height recovery and Cobb angle correction (P>0.05). Conclusion There was no difference in adjacent vertebral body re-facture rate of postoperative of unilateral PVP and bilateral PVP. Due to the short operation time was required of unilateral puncture, the patients suffered and received X-ray more less, the surgical method was relatively simple, it is recommended. If it is obvious uneven of bone cement distribution in operating, the bilateral puncture will be suggested.