改良单侧与双侧穿刺腰椎体成形术比较△

Comparison of modified unilateral puncture versus bilateral counterpart in percutaneous vertebroplasty for osteoporotic lumbar compression fracture

摘要:

［目的］对比改良单侧穿刺与双侧椎弓根入路椎体成形术（percutaneous vertebroplasty, PVP）治疗腰椎骨质疏松性压缩性骨折 （osteoporotic vertebral compression fracture, OVCF） 的临床疗效。［方法］ 2020 年 6 月—2020 年 12 月，86 例腰椎 OVCF 患者接受 PVP 手术，依据医患沟通结果，51 例采用经椎体后上缘入路单侧穿刺（单侧组），35 例采用常规双侧穿刺（双侧组），比较两组围手术期、随访及影像结果。［结果］ 两组患者均顺利完成手术，骨水泥渗漏单侧组有 18 例，双侧组有 13 例，均无严重并发症发生。单侧组术中 X 线曝光次数、住院费用均显著优于双侧组（P<0.05），但前者手术时间显著长于后者 （P<0.05），两组骨水泥注入量、骨水泥分布、骨水泥渗漏、术后下地时间、住院时间、早期 VAS 评分方面的差异均无统计学意义 （P>0.05）。两组患者均获随访 13~24 个月，平均 （15.8±2.1） 个月。随时间推移，两组 VAS 和 ODI 评分显著减少 （P< 0.05），而 JOA 评分显著增加 （P<0.05）；相应时间点，两组 VAS、ODI 和 JOA 评分的差异均无统计学意义 （P>0.05）。影像方面，与术前相比，术后两组伤椎前缘高度显著增加 （P<0.05），局部 Cobb 角显著减小 （P<0.05）。相应时间点，两组间伤椎前缘高度、局部 Cobb 角的差异均无统计学意义（P>0.05）。［结论］改良单侧穿刺 PVP 治疗腰椎 OVCF 可获得满意疗效，且具有优化手术流程、节省费用等优势，但具有一定的学习曲线。

Abstract:

[Objective] To compare the clinical outcomes of modified unilateral percutaneous vertebroplasty (PVP) versus bilateral PVP for osteoporotic vertebral compression fracture (OVCF) . [Methods] From June 2020 to December 2020, 86 patients underwent PVP for lumbar OVCF. According to doctor-patient communication, 51 patients received unilateral puncture via posterior upper margin of the vertebral body (unilateral group), while the other 35 patients received conventional bilateral puncture (bilateral group) . The perioperative period, follow-up and imaging consequences of the two groups were compared. [Results] All patients in both groups had operation complet- ed successfully, with bone cement leakage in 18 cases of the unilateral group, whereas 13 cases in bilateral group, without serious complica- tions. The unilateral group proved significantly superior to the bilateral group in terms of number of X- ray exposures and hospitalization costs (P＜0.05) , however, the former consumed significantly longer operative time than the latter (P＜0.05) , and there were no significant dif- ferences in bone cement injection amount, bone cement distribution, bone cement leakage, postoperative ambulation time, hospital stay and early VAS score between the two groups (P＞0.05) . During the follow-up lasted for 13~24 months, with an average of (15.8±2.1) months, the VAS scores and ODI decreased significantly (P＜0.05) , while JOA score increased significantly in both groups (P＜0.05) , and there were no significant differences in VAS, ODI and JOA scores between the two groups at any corresponding time points (P＞0.05) . Radiographical- ly, the anterior height of injured vertebrae increased significantly (P＜0.05) , whereas the local kyphotic Cobb angle decreased significantly in both groups postoperatively compared with those preoperatively (P＜0.05) , which proved not statistically significant between the two groups at any corresponding time points (P＞0.05) . [Conclusion] This modified unilateral puncture in PVP does achieve satisfactory clini- cal outcomes for lumbar OVCF, with advantages of optimizing surgical procedure and saving costs, despite of certain learning curve.