脊柱转移瘤单侧与双侧经皮椎体后凸成形术比较

Comparison of clinical outcomes of unilateral versus bilateral percutaneous kyphoplasty for spinal metastases

摘要:

［目的］ 比较单侧与双侧经皮椎体后凸成形术 （percutaneous kyphoplasty, PKP） 治疗脊柱转移瘤的临床效果。［方法］ 回顾性分析 2019 年 4 月—2020 年 4 月本院收治的 51 例脊柱转移瘤伴病理性骨折患者的临床资料，根据医患沟通结果， 28 例采用单侧 PKP，23 例采用双侧 PKP。比较两组围手术期、随访及影像资料。［结果］51 例均顺利完成手术，术中无严重并发症。两组术后下地时间及术后住院时间等方面的比较差异均无统计学意义（P>0.05），但是，单侧组术中失血量显著小于双侧组 （P<0.05），单侧组手术时间显著少于双侧组（P<0.05），双侧组骨水泥注入量显著多于单侧组（P<0.05）。单侧组骨水泥渗漏率显著高于双侧组（P<0.05）。术后随访 12 个月以上，随访期间，共 9 例出现邻近椎体再发类似骨折，3 例因原发肿瘤病情加重死亡。随时间推移，两组 VAS、ODI 和 KPS 评分均呈显著曲线变化（P<0.05）。相应时间点，两组间上述评分的差异均无统计学意义（P>0.05）。影像方面，单侧组骨水泥分布显著不及双侧组（P<0.05）；与术前相比，术后两组的伤椎高度显著增加，而局部后凸角显著减小（P<0.05），相应时间点两组上述影像学指标差异无统计学意义（P>0.05）。［结论］单侧与双侧 PKP 均可有效改善椎体转移瘤患者的生活质量，双侧 PKP 可降低术中骨水泥渗漏风险，并改善骨水泥在椎体内的分布。

Abstract:

[Objective] To compare the clinical outcomes of unilateral versus bilateral percutaneous kyphoplasty (PKP) for spinal metas- tases. [Methods] A retrospective study was conducted on 51 patients who received PKP for spinal metastasis complicated with pathological fracture in our hospital from April 2019 to April 2020. According to doctor-patient communication results, 28 patients underwent unilateral PKP, while the remaining 23 patients received bilateral PKP. The perioperative, follow-up and imaging data of the two groups were com- pared. [Results] All the 51 patients had PKP performed successfully without serious complications. Although there were no statistically sig- nificant differences between the two groups in terms of postoperative ambulation time and hospital stay (P＞0.05) , the unilateral group had significantly less intraoperative blood loss, whereas significantly higher bone cement leakage rate than the bilateral group (P＜0.05) . The op- eration time in unilateral group was significantly shorter than the bilateral group (P＜0.05) , the bone cement injection volume in bilateral group was significantly higher than the unilateral group (P＜0.05) . During the follow-up period lasted for more than 12 months, 9 patients developed similar fractures in the adjacent vertebral body, and 3 patients died due to the aggravation of the primary tumor. The VAS, ODI and KPS scores showed significant curve changes over time in both groups (P＜0.05) , however, there was no statistical significance in the abovementioned scores between the two groups at any corresponding time points (P＞0.05) . In terms of imaging evaluation, the unilateral group proved significantly inferior to the bilateral group in term of bone cement distribution (P＜0.05) . The height of injured vertebrae signif- icantly increased, while the local kyphosis angle significantly decreased postoperatively in both groups compared with those before surgery (P＜0.05) , whereas there was no statistical difference in the above imaging indicators between the two groups at any corresponding time points (P＞0.05) . [Conclusion] Both unilateral and bilateral PKP do effectively improve the quality of life for vertebral metastasis, by con- trast, the bilateral PKP reduce the risk of bone cement leakage, while improve the bone cement distribution in the vertebral body during oper- ation.