单侧穿刺椎体成形骨水泥分布不良两种二次填充比较

Comparison of two secondary fillings for poorly distributed bone cement in unilateral percutaneous vertebroplasty

摘要:

[目的] 比较初次单侧穿刺椎体成形术中骨水泥分布不良时,同侧与对侧二次椎弓根穿刺骨水泥填充的临床效果。[方法] 前瞻性纳入76例单侧椎体成形术中骨水泥分布不满意需二次填充的患者,采用抽签法随机分为两组,38例行同侧椎弓根二次穿刺,并填充骨水泥(同侧组);另外38例行对侧椎弓根二次穿刺,并填充骨水泥(对侧组)。比较两组围手术期、随访及影像学结果。[结果] 两组患者均顺利完成二次穿刺及骨水泥填充,未发生骨水泥渗漏等严重并发症。同侧组手术时间[min,(35.1±1.6) vs (47.6±1.7), P<0.001]、二次穿刺时间[min,(11.1±1.0) vs (22.7±1.4), P<0.001]、二次操作X线曝光次数[次,(8.4±0.9) vs (13.2±0.9), P<0.001]、住院费用[万元,(1.7±0.1) vs (2.1±0.1), P<0.001]均显著优于对侧组。两组骨水泥注入量、骨水泥最终分布情况、术后下地行走时间及住院时间的差异均无统计学意义(P>0.05)。患者随访平均(15.4±1.1)个月,两组患者完全负重时间的差异无统计学意义(P>0.05)。随时间推移,两组VAS、ODI评分均显著改善(P<0.05),相应时间点,两组间上述评分的差异无统计学意义(P>0.05)。影像方面,与术前相比,两组患者术后1周及末次随访时,伤椎前缘高度及局部Cobb角均显著改善(P<0.05);相应时间点两组间上述影像指标的差异均无统计学意义(P>0.05)。[结论] 当初次单侧穿刺骨水泥分布不良时,同侧椎弓根二次穿刺骨水泥填充和传统对侧椎弓根二次穿刺骨水泥填充均可缓解疼痛、改善功能、提高患者生活质量。相比之下,同侧穿刺具有手术时间短、术中透视次数少及手术费用低的优势。

Abstract:

[Objective] To compare the clinical outcome of ipsilateral secondary pedicle puncture and bone cement filling versus the contralateral counterpart for poorly distributed bone cement in the unilateral percutaneous vertebroplasty (PVP). [Methods] A total of 76 patients who had unsatisfactory bone cement distribution and requiring secondary filling in unilateral PVP were included into this prospective study, and were randomly divided into two groups by lottery. Of them, 38 patients received ipsilateral secondary pedicle puncture and filling bone cement (the ipsilateral group), the other 38 patients underwent contralateral secondary pedicle puncture and filling bone cement (the contralateral group). The perioperative, follow-up, and imaging data of the two groups were compared. [Results] All patients in both groups had the secondary puncture and bone cement filling performed smoothly without serious complications, such as bone cement leakage. The ipsilateral group proved significantly superior to the contralateral group in terms of operation time [min, (35.1±1.6) vs (47.6±1.7), P<0.001], secondary puncture time [min, (11.1±1.0) vs (22.7±1.4), P<0.001], the number of X-ray exposures during the secondary operation [times, (8.4±0.9) vs (13.2±0.9), P<0.001], and hospitalization cost [10 k yuan, (1.7±0.1) vs (2.1±0.1), P<0.001]. However, there were no statistically significant differences in the amount of bone cement injection, the final distribution of bone cement, the postoperative ambulation time and the hospitalization time between the two groups (P>0.05). The average follow-up period lasted for (15.4±1.1) months, and there was no a statistically significant difference in the time to regain full weight-bearing between the two groups (P>0.05). Both groups showed significant improvement in VAS and ODI scores over time (P<0.05), whereas there were no statistically significant differences in the above scores between the two groups at any time points accordingly (P>0.05). As for terms of imaging, the anterior height of the injured vertebra and the local Cobb angle were significantly improved in both groups 1 week and the last follow-up time compared with those preoperatively (P<0.05), whereas which proved not significantly different between the two groups at any time points accordingly (P>0.05). [Conclusion] As the bone cement distribution is poor in the first unilateral vertebroplasty, secondary pedicle puncture and bone cement filling on both the ipsilateral side and traditional contralateral side do relieve pain, improve function, and enhance the quality of life of patients. In contrast, the secondary ipsilateral operation has the advantages of shortening the operation time, reducing the number of intraoperative X-ray exposures, and lowering the surgical cost.