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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:

期数:

2021年03期

页码:

140-146

栏目:

脊柱专题

出版日期:

2021-06-05

文章信息/Info

Title:

Clinical observation of unilateral-beside approach PKP in treatment of lumbar OVCF

作者:

陈宏亮1; 郭开今1; 段钢2; 袁峰1; 陈向阳1

221002 徐州医科大学附属医院骨科1；221002 徐州医科大学第二附属医院骨科2

Author(s):

Chen Hongliang1;  Guo Kaijin1;  Duan Gang2;  Yuan Feng1;  Chen XiangYang1.

1Department of Orthopaedics, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China; 2Department of Orthopaedics, the Second Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China

关键词:

腰椎;  骨质疏松性骨折;  单侧;  椎弓根旁路;  经皮椎体成形术

Keywords:

Lumbar spine;  Osteoporosis fractures;  Unilateral;  Lateral pedicle approach;  Percutaneous vertebroplasty

DOI:

10.3877/cma.j.issn.2096-0263.2021.03.003

文献标志码:

A

摘要:

目的 对比单侧椎弓根旁入路与双侧椎弓根入路经皮椎体成形术治疗骨质疏松性腰椎压缩骨折的临床效果。方法 回顾性分析2017年7月至2019年1月徐州医科大学附属医院经皮椎体成形术治疗的68例（共73节椎体）骨质疏松性腰椎压缩骨折病例，根据手术入路方式分为经单侧椎弓根旁入路组（单侧组）为32例35椎，其中男性7例、女性25例，年龄（61～79）岁，平均（69.7±5.3）岁；经双侧椎弓根入路（双侧组）为36例38椎，其中男9例、女27例，年龄（62～81）岁，平均（71.5±6.8）岁，比较两组手术指标、影像学指标以及功能障碍指标。结果 两组患者均完成3～6个月，平均（5.0±0.9）个月的随访观察，两组患者术后1 d、3个月的腰腿痛视觉模拟评分（VAS）评分、Oswestry功能障碍指数（ODI）均较术前明显减低（P＜0.05）；单侧组手术时间为（37±6）min、术中出血量为（15±3）ml、透视次数为（17±4）次、骨水泥注入量为（4.8±1.1）ml，均少于双侧组[手术时间：（51±8）min，术中出血量：（23±5）ml，透视次数：（26±5）次，骨水泥注入量：（5.7±1.4）ml]（t=7.967，t=7.636，t=7.72，t=3.035，P＜0.001）。单侧组伤椎术后1 d和3个月的后凸Cobb角值分别为（9±3）°和（10±3）°、同时间点的椎体前缘压缩程度分别为：（15±6）%和（15±6）%，双侧组伤椎术后1 d和3个月的后凸Cobb角值分别为（10±3）°和（10±3）°。同时间点的椎体前缘压缩程度分别为：（17±5）%和（16±6）%，两组伤椎的术后后凸Cobb角及椎体前缘压缩程度均较术前改善（P＜0.05），但两组间的骨水泥弥散理想程度、术后1 d与3个月的后凸Cobb角及椎体高度恢复率之间，差异均无统计学意义；单侧入路组骨水泥无症状渗漏率为9.38%（3/32），双侧入路组为11.11%（4/36），差异无统计学意义。结论 单侧椎旁入路和双侧椎弓根入路经皮椎体成形术均能快速、有效地治疗腰椎骨质疏松性椎体骨折，且单侧入路经皮椎体成形手术可以相对减少手术时间和透视次数、骨水泥用量、出血量。

Abstract:

Objective To compare the clinical effect of unilateral parapedicle approach and bilateral pedicle approach in the treatment of osteoporotic lumbar vertebral compression fractures. Methods From July 2017 to January 2019, 68 patients (73 vertebrae) with osteoporotic lumbar compression fractures treated by percutaneous vertebroplasty in our hospital were retrospectively analyzed. According to the surgical approach, they were divided into unilateral parapedicle approach group (unilateral group) with 32 cases （35 vertebrae）, including 7 males and 25 females, aged 61-79 years (average, 69.7±5.3) years, and the bilateral pedicle approach (bilateral group) had 36 patients (38 vertebrae), including 9 males and 27 females, aged 62-81 years, with an average of (71.5±6.8) years. The operation index, imaging index and dysfunction index of the two groups were compared. Results All patients in the two groups were followed up for 3-6 months. Patients in the two groups had significantly lower visual analogue scale (VAS) scores for lumbocrural pain and Oswestry Disability Index (ODI) before operation and 1 d and 3 months after operation (P<0.05). The operation time, intraoperative bleeding volume, fluoroscopic times, and bone cement injection volume in the unilateral group were (37±6) min, (15±3) mL, and (17±4) ml, respectively, which were less than those in the bilateral group [operation time: (51±8) min, intraoperative bleeding volume: (23±5) mL, and fluoroscopic times: (5.7±1.4) ml] (t=7.967, t=7.636, t=7.72, t=3.035, P<0.05). In the unilateral group, the Cobb angles of kyphosis were (9±3) and (10±3) one day and three months after surgery, (15±6)% and (15±6)% at the same time point, respectively. In the bilateral group, the Cobb angles of kyphosis were (10±3) and (10±3) one day and three months after surgery, respectively. The leading edge compression at the same time point was: (17±5)% and (16±6)%, respectively. The kyphoscolic Cobb angle and the compression of the leading edge of the vertebral body in the two groups were both improved after operation (P<0.05), but there were no significant differences in the ideal degree of cement dispersion, kyphoscolic Cobb angle 1 d and 3 months after operation and the recovery rate of vertebral body height between the two groups. The asymptomatic leakage rate of bone cement was 9.38%(3/32) in the unilateral approach group and 11.11%(4/36) in the bilateral approach group. Conclusion Both unilateral paravertebral approach and bilateral pedicle access percutaneous vertebroplasty can treat lumbar osteoporotic vertebral fractures quickly and effectively, and unilateral percutaneous vertebroplasty can relatively reduce the operation time and fluoroscopy times, bone cement consumption and bleeding volume.

备注/Memo

备注/Memo:

基金项目：江苏省科技厅自然科学基金面上项目（BK20201154）

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更新日期/Last Update: 2021-06-29