单侧与双侧入路行椎体后凸成形术的效果比较

目的对比单侧入路与双侧入路行经皮球囊扩张椎体后凸成形术(PKP)治疗胸腰椎骨质疏松性骨折的疗效。方法回顾性统计北京水利医院2011年6月～2015年10月收治的69例胸腰椎骨质疏松性骨折,其中男性19例,女性50例,年龄52～91岁,平均66.7岁。采用单侧入路或双侧入路行PKP治疗,记录骨水泥用量、手术时间、VAS评分、Cobb角变化度、椎体高度压缩率、恢复率等指标,术后随访时间1个月。结果单侧入路组的手术时间为(28.6±6.4)min,显著优于双侧入路组的(40.1±9.6)min(P0.05)。两组的骨水泥用量分别为(4.2±1.7)m L和(4.5±2.0)m L无统计学差异(P0.05)。两组的术前Cobb角分别为(19.5±7.9)°和(21.1±9.1)°,术后分别为(11.6±5.5)°和(12.2±5.8)°,两组术后Cobb角均较术前有明显改善(P0.05),但两组间无显著统计学差异。两组术前椎体高度压缩率分别为(31.7±11.6)%和(34.2±15.1)%,术后分别为(12.4±5.7)%和(12.8±4.9)%,术后椎体高度较术前均有明显恢复(P0.05),恢复率分别为(60.9±20.1)%和(62.6±22.4)%,两组间无显著统计学差异。两组VAS评分,术前分别为(7.65±1.91)和(7.82±1.75),术后即刻分别为(3.88±1.12)和(4.03±1.02),术后1d分别为(2.36±0.49)和(2.34±0.53),术后3d分别为(1.48±0.33)和(1.41±0.41),术后1月分别为(0.12±0.05)和(0.19±0.06)。术后较术前疼痛均有明显缓解(P0.05),但两组间无显著统计学差异。结论单、双侧入路椎体后凸成形术治疗胸腰椎骨质疏松性骨折,均能达到满意疗效,若采用C型臂X线机透视,单侧入路手术时间更短。

Comparative study of percutaneous kyphoplasty with unilateral or bilateral approach

Objective To compare the differences of percutaneous balloon kyphoplasty (PKP) in treating osteoporotic thoracolumbar vertebral fractures through unilateral versus bilateral approach. Methods The data of 69 patients who suffered from osteoporotic thoracolumbar vertebral fractures were retrospectively analyzed, who were admitted from Jun.2011 to Oct.2015 and were treated by PKP through unilateral or bilateral approach.The cement usage,operation time,VAS scores,pre-and post-operative Cobb angle and reduction of vertebral height were analyzed. Results The operating time of unilateral approach was (28.6±6.4) min,and was significantly shorter than that of bilateral approach of (40.1±9.6) min (P<0.05).The cement volumes of the two groups were (4.2±1.7)mL and (4.5±2.0)mL,respectively,which showed no statistical difference(P>0.05).The post-operative Cobb angle of the two groups was (11.6±5.5)° and (12.2±5.8)°,respectively,which was significantly reduced than that of pre-operation(19.5±7.9)° and (21.1±9.1)°,respectively,P<0.05],but there was no significant difference between the two groups.The post-operative percentage of the compression of vertebral height of the two groups was (12.4±5.7)% and (12.8±4.9)%,respectively,and was more significantly restored than those of pre-operation(31.7±11.6)% and (34.2±15.1%),respectively, P<0.05].The restoration of the two groups was (60.9±20.1)% and (62.6±22.4)% respectively,but there was no significant difference between the two groups.The pre-operative VAS scores of the two groups were (7.65±1.91) and (7.82±1.75),were (3.88±1.12) and (4.03±1.02) immediately after operation,were (2.36±0.49) and (2.34±0.53) at postoperative day 1,were (1.48±0.33) and (1.41±0.41) at postoperative day 3,and were (0.12±0.05) and (0.19±0.06) at 1 month after operation.The pain in both groups was significantly relieved after surgery,but showed no difference between the two groups. Conclusion Both approaches are efficient,but unilateral approach takes less time while using C arm X-ray.