单、双侧入路经皮椎体后凸成形术治疗骨质疏松性、肿瘤性椎体新鲜性压缩骨折的疗效比较

目的 探讨经皮椎体后凸成形术(PKP)单侧与双侧椎弓根入路治疗椎体新鲜性压缩骨折的效果.方法 共78例96节骨质疏松性、肿瘤性椎体新鲜性压缩性骨折患者,其中单侧经椎弓根入路单球囊58例69节椎体,双侧经椎弓根入路20例27节椎体,其中肿瘤病椎2例4节椎体,采用单球囊或双球囊扩张器行椎体后凸成形术.术前、术后2周、2年进行疼痛视觉类比评分(VAS)、测量椎体高度恢复率、后凸Cobb角.结果 经2周～2年随访,单侧组及双侧组术后2周及术后2年疼痛视觉类比评分(VAS)、后凸Cobb角较术前均减少(P＜0.05).术后2周、后2年后凸Cobb角恢复率单侧组分别为51.2％、44.5％;双侧组为53.2％、47.8％.术后2周、2年椎高恢复率单侧组分别为47.2％、44.5％;双侧组分别为51.3％、47.2％.术后2周、2年VAS评分、后凸Cobb角及椎高恢复率两组比较差异无统计学意义(P＞0.05),VAS评分术后2年较术后2周骨折均能恢复伤椎体高度、纠正后凸Cobb角并缓解疼痛.术后针对骨质疏松症、肿瘤的病因治疗可提高疗效.结论 采用单侧与双侧经椎弓根入路经皮椎体后凸成形术治疗骨质疏松性、肿瘤性椎体新鲜性压缩性骨折均能恢复伤椎体高度、纠正后凸Cobb角并缓解疼痛.

Unipedicular versus bipedicular percutaneous kyphoplasty in the treatment of osteoporotic,neoplastic fresh vertebral compression fractures

Objective To investigate the clinical efficacy of unipedicular and bipedicular percutaneous kyphoplasty (PKP) in the treatment of fresh vertebral compression fractures.Methods 78 cases of osteoporotic, neoplastic fresh vertebral compression fractures (96 segments) were selected.58 patients (69 segments) underwent unipedicular PKP, while the other 20 patients (27 segments) bipedicular PKP, in whom 2 cases of neoplastic fresh vertebral compression fractures (4 segments) underwent PKP with single or double balloon expander.Visual analogue scale (VAS) was assessed and the recovery of the height of vertebral bodies and kyphosis Cobb angle were measured before and 2 weeks and 2 years after the treatment.Results VAS score and kyphosis Cobb angle decreased more 2 weeks and 2 years after than before the treatment in both groups.The recovery rates of kyphosis Cobb angle 2 weeks and 2 years after the treatment were 51.2％ and 44.5％ in the unipedicular group and were 53.2％ and 47.8％ in the bipedicular group.The recovery rate of the height of vertebral bodies 2 weeks and 2 years after the treatment were 47.2％ and 44.5％ in the unipedicular group and were 51.3％ and 47.2％ in the bipedicular group.There were no statistical differences in VAS score, kyphosis Cobb angle, and the recovery rate of the height of vertebral bodies between these two groups 2 weeks and 2 years after the treatment.VAS score, kyphosis Cobb angle, and the recovery rate of the height of vertebral bodies were better 2 years than 2 weeks after the treatment in both two groups.Postoperative etiological treatment aiming at osteoporosis, tumor can improve clinical efficacy.Conclusions Unipedicular and bipedicular percutaneous kyphoplasty in the treatment of osteoporotic, neoplastic fresh vertebral compression fractures can both restore the height of injured vertebral bodies, correct kyphosis Cobb angle, and relieve pain.