单球囊双侧序贯扩张经皮椎体后凸成形术治疗骨质疏松性椎体压缩性骨折

目的 探讨单球囊双侧序贯扩张经皮椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩性骨折(OVCF)的临床疗效.方法 2017年1月—2018年6月,采用PKP治疗OVCF患者80例,其中40例行单球囊双侧序贯扩张(观察组),40例行单球囊单侧扩张(对照组).记录2组手术时间、骨水泥注入量、骨水泥弥散系数;术前、术后7 d、末次随访时采用疼痛视觉模拟量表(VAS)评分评估患者疼痛程度,拍摄X线片并测量Cobb角、椎体前缘高度,评价患者畸形矫正及椎体高度恢复效果;观察2组患者椎体再塌陷、骨水泥渗漏发生情况.结果 所有手术顺利完成.所有患者随访超过2年.观察组手术时间长于对照组,骨水泥注入量多于对照组,骨水泥弥散系数高于对照组,差异均有统计学意义(P<0.05);2组患者住院时间差异无统计学意义(P>0.05).术后7 d和末次随访时2组患者VAS评分较术前下降,椎体前缘高度较术前增加,Cobb角较术前减小,差异均有统计学意义(P<0.05);末次随访时观察组Cobb角小于对照组,椎体前缘高度高于对照组,差异均有统计学意义(P<0.05).2组患者椎体再塌陷、骨水泥渗漏发生率差异均无统计学意义(P>0.05).结论 单球囊双侧序贯扩张PKP治疗OVCF能够提升骨水泥注入量和弥散效果,减轻术后矫正效果的丢失,且不增加骨水泥渗漏风险.

Percutaneous kyphoplasty with single balloon and bilateral sequential expansion for treatment of osteoporotic vertebral compression fractures

Objective To explore the clinical effect of percutaneous kyphoplasty(PKP) with single balloon and bilateral sequential expansion in the treatment of osteoporotic vertebral compression fractures(OVCF). Methods From January 2017 to June 2018,a total of 80 patients with OVCF were treated with PKP,of which 40 were treated with single balloon bilateral sequential expansion(observation group),and 40 with single balloon unilateral expansion(control group). The operation time,amount of bone cement injection and dispersion coefficient of bone cement were recorded in the 2 groups. Visual analogue scale(VAS) score was used to evaluate pain symptoms and Cobb''s angle and anterior height of vertebral body detected on roentgenogrphs at pre-operation,postoperative 7 d and final follow-up were used to evaluate the effect of deformity correction and vertebral height recovery. The occurrence of vertebral recollapse and bone cement leakage were observed in the 2 groups. Results All the operations were successfully completed. All the patients were followed up for more than 2 years. The operation time of the observation group was significantly higher than that of the control group,and the amount of bone cement injection and dispersion coefficient of bone cement were significantly higher than those of the control group(P<0.05). There was no statistically significant difference in hospital stay between the 2 groups(P>0.05). Compared with those at pre-operation,the VAS score decreased,the anterior height of vertebral body increased and the Cobb''s angle decreased in the 2 groups at postoperative 7 d and final follow-up,all with a statistical significance(P<0.05). However,the observation group had a lower Cobb''s angle and a higher anterior height of vertebral body at the final follow-up compared with the control group(P<0.05). There was no significant difference in the incidence of vertebral recollapse and bone cement leakage between the 2 groups(P>0.05). Conclusion PKP with single balloon bilateral sequential expansion for OVCF can increase the amount of bone cement injection and dispersion effect,and reduce the loss of postoperative correction without increasing the risk of bone cement leakage.