胸腰椎骨质疏松性压缩骨折三种椎体成形比较

Comparison of three types of vertebroplasty for thoracolumbar osteoporotic vertebral compression fractures

摘要:

[目的] 探索经皮弯角椎体成形术 （percutaneous curved vertebroplasty, PCVP）、单侧经皮椎体成形术 （unilateral per- cutaneous vertebroplasty, UPVP）与双侧经皮椎体成形术（bilateral percutaneous vertebroplasty, BPVP）治疗胸腰椎骨质疏松性椎体压缩骨折的临床疗效。[方法]回顾性分析 2018 年 5 月—2019 年 4 月本院诊治的 78 例胸腰椎骨质疏松性椎体压缩骨折患者的临床资料。根据医患沟通结果，30 例采用 PCVP，36 例采用 UPVP，22 例采用 BPVP。比较三组围手术期、随访和辅助检查结果。[结果] PCVP 组手术时间 [(35.9±4.2) min vs (39.3±5.0) min vs (42.6±5.0) min, P＜0.001]、术中 X 线曝光次数 [(8.3±1.2) 次 vs (9.7±1.7) 次 vs (18.2±2.6) 次, P＜0.001]、骨水泥注入量 [(5.9±1.1) mL vs (6.7±1.4) mL vs (7.6±1.5) mL, P＜0.001]、术中失血量 [(12.4± 1.6) mL vs (25.7±2.0) mL vs (28.3±6.0) mL, P＜0.001]、术后下地时间 [(6.5±1.1) h vs (7.8±1.4) h vs (8.5±0.9) h, P＜0.001]、住院时间 [(5.9±1.2) d vs (8.0±2.0) d vs (8.0±1.8) d, P＜0.001] 、住院费用 [(1.9±0.4) 万元 vs (2.1±0.5) 万元 vs (2.2±0.4) 万元, P＜0.001] 均显著低于 UPVP 组和 BPVP 组。PCVP 组和 BPVP 组的骨水泥渗漏发生率 （0 vs 4.6% vs 26.9%, P 0.001） 显著低于 UPVP 组。随访时间平均 （15.1±2.5） 个月，随时间推移，三组 VAS 评分、ODI 评分均显著降低 （P＜0.05）。术后 2 d 及末次随访时，PCVP 组 VAS [(2.2±1.2) vs (2.8±0.7) vs (2.9±0.6), P=0.005; (1.3±0.6) vs (2.2±1.2) vs (1.8±0.9), P 0.007]、ODI 评分 [(18.8±1.9) vs (20.3±2.1) vs (21.5± 2.2), P＜0.001; (13.1±1.3) vs (16.3±1.6) vs (17.1±1.5), P 0.001] 显著优于 UPVP 组及 BPVP 组。影像方面，随时间推移，三组椎前缘高度（anterior vertebral height, AVH）、伤椎后缘高度高度（posterior vertebral height, PVH）、局部后突 Cobb 角（local kyphotic an- gle, LKA）、胸腰段后凸角 （thoracolumbar kyphotic angle, TLK） 均显著改善 （P＜0.05），术后相应时间点 PCVP 组上述影像指标均显著优于 UPVP、BPVP 组（P＜0.05）。[结论]PCVP 治疗胸腰椎 OVCF 效果确切，有利于骨水泥在骨折椎体内均匀分布，更好地改善腰椎功能，且具有创伤小、操作简单、用时短、透视次数少及术后恢复快等优点。

Abstract:

[Objective] To explore the clinical efficacy of percutaneous curved vertebroplasty (PCVP), by comparison with unilateral percutaneous vertebroplasty (UPVP and bilateral percutaneous vertebroplasty (BPVP) for thoracolumbar osteoporotic vertebral compression fractures (OVCF). [Methods] A retrospective study was done on 78 patients who had thoracolumbar OVCF treated surgically in our hospital from May 2018 to April 2019. Based on doctor-patient communication, 30 patients were treated with PCVP, the other 36 with UPVP, and the remaining 22 with BPVP. The documents regarding perioperative period, follow-up and auxiliary examination were compared among the three groups. [Results] The PCVP group proved significantly superior to the UPVP and BPVP in terms of operation time [(35.9±4.2) min vs (39.3±5.0) min vs (42.6±5.0) min, P 0.001], intraoperative X ray exposure times [(8.3±1.2) times vs (9.7±1.7) times vs (18.2±2.6) times, P 0.001], bone cement injection volume [(5.9±1.1) mL vs (6.7±1.4) mL vs (7.6±1.5) mL, P 0.001], intraoperative blood loss [(12.4±1.6) mL vs (25.7±2.0) mL vs (28.3±6.0) mL, P 0.001], the ambulation time [(6.5±1.1) hours vs (7.8±1.4) hours vs (8.5±0.9) hours, P 0.001], hospital stay [(5.9±1.2) days vs (8.0±2.0) days vs (8.0±1.8) days, P 0.001], hospitalization cost [(1.9±0.4) 10 k yuan vs (2.1±0.5) 10 k yuan vs (2.2± 0.4) 10 k yuan, P 0.001]. The incidences of bone cement leakage in PCVP and BPVP groups were significantly lower than that in UPVP group (0 vs 4.6% vs 26.9%, P 0.001). With time of the follow-up period lasted for (15.1±2.5) months in a mean, the VAS and ODI scores of the three groups were significantly decreased (P＜0.05). At 2 days after surgery and the last follow-up, the PCVP group was significantly better than the UPVP group and the BPVP group in terms of VAS score [(2.2±1.2) vs (2.8±0.7) vs (2.9±0.6), P 0.005; (1.3±0.6) vs (2.2±1.2) vs (1.8±0.9), P=0.007] and ODI score [(18.8±1.9) vs (20.3±2.1) vs (21.5±2.2), P＜0.001; (13.1±1.3) vs (16.3±1.6) vs (17.1±1.5),P＜0.001]. As for images, vertebral anterior height (AVH), posterior vertebral height (PVH), local kyphotic angle (LKA), thoracolumbar kyphotic angle (TLK) were significantly improved over time (P＜0.05), which in PCVP group were significantly better than those in UPVP and BPVP groups at corresponding time points after surgery (P＜0.05). [Conclusion] PCVP is effective in the treatment for thoracolumbar OVCF, which is conducive to the uniform distribution of bone cement in fractured vertebrae and better improvement of lumbar function, and has the advantages of less trauma, simple operation, short time, fewer fluoroscopy times and quick postoperative recovery