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

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,P0.001)。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,P0.001),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。

Comparison between the unipedicular and bipedicular kyphoplasty in treatment of osteoporotic vertebral compression fracture

【Abstract】 Objective To observe and compare the efficacy of unipedicular and bipedicular percutaneous kyphoplasty for treating osteoporotic vertebral compressive fractures. Methods A total 32 patients with osteoporotic vertebral compression fractures in single segment vertebral body were included in the study. Of them,16 cases underwent unipedicular percutaneous kyphoplasty (unipedicular group) and another 16 were received bipedicular percutaneous kyphoplasty bipedicular group)..The complication, Kyphosis Cobb's angle, pain relief index score (VAS score), ADL score and operation duration were compare between two groups. Results There was no significant difference in occurrence of complication, pain relief and correction of spinal Kyphosis Cobb's angle in 6 month after operation between two groups. The operation duration of unipedicular kyphoplasty group was short than that of bipedicular kyphoplasty group (P>0.05). After operation in 6 months, Cobb's angle in unipedicular group was 4.8°±0.5° and less than that in bipedicular group (t=-14.840, P<0.001). VAS score in unipedicular group was 2.2±0.3 and less than that in bipedicular group (2.4±0.3)(t=-1.886, P=0.069). Kyphosis Cobb’s angle, pain relief index score (VAS score), ADL score in two groups were getting better than that before operation. Conclusion〓The effect of pain relief, Kyphosis Cobb's angle correctic and occurrence of complication between unipedicular with bipedicular kyphoplasty are similar, but the unipedicular kyphoplasty has the advantage of less operation time and simpler procedure.