摘要
目的:探讨经皮椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩性骨折经单侧与双侧穿刺的临床疗效的差异。方法:将收治的椎体骨质疏松性压缩性骨折患者根据住院号单双号进行随机分组。双侧穿刺组共41例46个椎体,男性4例,女性37例;年龄53-82岁,平均70.8岁。单侧穿刺组共50例69个椎体,男性6例,女性44例;年龄55-87岁,平均73.1岁。全部患者都在"C"型臂透视机引导下,经皮单侧或者双侧穿刺完成手术。术后经过随访观察,随访期间定时摄脊柱正侧位X线片,测量病变椎体前、中、后缘高度和椎体后凸角度变化,采用视觉模拟评分法(VAS)评估腰背痛的缓解情况,应用Oswestry功能障碍指数判断生活质量。结果:全部患者顺利完成穿刺,单侧穿刺组平均每个椎体手术时间(40±22)min,双侧手术组平均每个椎体手术时间(54±25)min,两组间差异有统计学意义(P<0.05);单侧手术组每个椎体平均骨水泥注入量(2.9±1.8)ml,双侧手术组每椎体平均骨水泥注入量(5.4±2.2)ml,两组间差异有统计学意义(P<0.05);术中透视次数,单侧手术组(11.9±2.2),双侧手术组(19.5±2.0),两组间差异有统计学意义(P<0.05)。随访12-36个月,疼痛视觉模拟评分法(visual analogus scale,VAS)评分,单侧手术组术前平均为:7.9±2.1,术后2.1±1.8,末次随访2.4±2.2,手术前后差异有统计学意义(P<0.05);双侧手术组术前平均为:7.7±2.2,术后2.2±1.8,末次随访2.5±2.3,手术前后差异有统计学意义(P<0.05);椎体后凸角矫正,单侧手术组Cobb′s恢复率平均为(52.8±6.6)°,双侧手术组平均矫正(55.1±6.0)°,各组手术前后比较,差异有统计学意义(P<0.05)。两组间上述各指标比较,差异无统计学意义。两组术后Oswestry功能障碍指数两组间差异无统计学意义。91例中发生骨水泥渗漏8例,均无神经症状。结论:椎体后凸成形术治疗骨质疏松性骨折经单侧与双侧穿刺的疗效相当,但单侧穿刺组具有手术操作短、透视次数少、骨水泥注入量少等优点。
Objective： To evaluate the efficacy difference of unilateral versus bilateral percutaneous kyphoplasty for the treatment of osteoporotic compression fractures.Methods： Between January 2008 and March 2011,the patients with osteoporotic compression fractures were randomly divided into unilateral and bilateral puncture groups.Patients underwent unilateral or bilateral kyphoplasty with bone cement.The X-ray films of lateral spinal were taken during follow up.The changes of anterior,middle and posterior vertebral body height and the convex angle were measured.The pain visual analogue score（VAS） was used to determine the relief of low back pain,and the Oswestry functional disability index was used to assess the quality of life.Results： The mean operation time,the mean volume of cement injected per vertebra,and the times of intraoperative fluoroscopy of unilateral group was respectively less than that of bilateral group（all P0.05）.There were no significant differences in VAS,Cobb＇s angle,Oswestry functional disability index,and the anterior,middle and posterior vertebral body height between the two groups after puncture.Conclusion： Unilateral kyphoplasty for osteoporotic compression fractures is similar to bilateral kyphoplasty in clinical outcomes.But shorter surgery time,less fluoroscopy times and cement injection were the advantages of unilateral kyphoplasty.
出处
《武汉大学学报（医学版）》
CAS
北大核心
2012年第4期567-570,共4页
Medical Journal of Wuhan University
