摘要
目的比较单侧和双侧穿刺经皮椎体后凸成形术(PKP)治疗ⅢA型急性症状性骨质疏松性腰椎骨折(ASOLF)的疗效。方法采用回顾性队列研究分析2016年4月至2018年2月西安交通大学附属红会医院收治的117例ⅢA型ASOLF患者的临床资料,其中男32例,女85例;年龄60~88岁[(68.3±5.7)岁]。损伤节段:L_(1)35例,L_(2)38例,L_(3)26例,L_(4)18例。均采用PKP治疗。61例采用横突中点-关节突移行部为穿刺点(单侧穿刺组),56例采用传统的"2点"和"10点"为穿刺点(双侧穿刺组)。比较两组手术时间、患者与术者辐射暴露量及骨水泥注入量;比较术前、术后第一天及末次随访时伤椎Cobb角、伤椎前缘高度、视觉模拟评分(VAS)及Oswestry功能障碍指数(ODI);观察术中及术后并发症情况。结果患者均获随访24~35个月[(26.3±4.7)个月]。单侧穿刺组手术时间为(20.4±5.6)min,患者辐射暴露量为(1.08±0.44)mSv,双侧穿刺组为(37.5±9.2)min、(2.24±0.58)mSv(P均<0.01);两组术者辐射暴露量和骨水泥注入量差异无统计学意义(P均>0.05)。术后第一天单侧穿刺组与双侧穿刺组伤椎Cobb角分别为(22.4±10.7)°、(23.4±11.1)°,末次随访时分别为(24.3±8.3)°、(23.5±9.5)°,较术前的(29.6±9.7)°、(30.6±12.9)°明显降低(P均<0.01)。术后第一天单侧穿刺组与双侧穿刺组伤椎前缘高度分别为(80.4±12.6)%、(78.8±11.9)%,末次随访时分别为(79.3±10.7)%、(77.4±11.2)%,较术前的(65.7±6.3)%、(66.4±9.7)%明显恢复(P均<0.01)。术后第一天单侧穿刺组与双侧穿刺组VAS分别为(2.1±0.5)分、(2.3±1.1)分,末次随访时分别为(1.9±0.8)分、(2.0±0.6)分,较术前的(7.1±0.7)分、(7.2±0.9)分明显降低(P均<0.01)。术后第一天单侧穿刺组与双侧穿刺组ODI分别为21.1±9.7、22.9±7.9,末次随访时分别为18.5±4.6、19.8±9.4,较术前的72.7±4.5、73.1±3.7明显降低(P均<0.01)。两组间上述四项指标各时相点差异无统计学意义,且两组内伤椎Cobb角、伤椎前缘高度、VAS及ODI末次随访与术后第一天差异无统计学意义(P均>0.05)。单侧穿刺组骨水泥渗漏13例[21%(13/61)],双侧穿刺组18例[29%(18/56)](P<0.05)。单侧穿刺组相邻椎体骨折4例[7%(4/61)],双侧穿刺组5例[9%(5/56)](P>0.05)。双侧穿刺组8例[14%(8/56)]出现关节突损伤引起的腰背部疼痛,经非手术治疗1个月后症状缓解,而单侧穿刺组无一例发生(P<0.01)。结论单侧及双侧穿刺PKP治疗ⅢA型ASOLF均可获得满意的临床疗效,但前者具有手术时间短、患者辐射暴露量少、骨水泥渗漏率及关节突损伤发生率低等优势。
Objective To evaluate the efficacy of unilateral and bilateral percutaneous kyphoplasty(PKP)in the treatment of type IIIA acute symptomatic osteoporotic lumbar fracture(ASOLF).Methods A retrospective cohort study was conducted to analyze the clinical data of 117 patients with type IIIA ASOLF admitted to Honghui Hospital of Xi′an Jiaotong University from April 2016 to February 2018,including 32 males and 85 females,aged 60 to 88 years[(68.3±5.7)years].Injury segments were located at L_(1) in 35 patients,at L_(2) in 38,at L_(3) in 26 and at L_(4) in 18.All patients were treated with PKP.A total of 61 patients were treated using the midpoint of the transverse process-articular process displacement as the puncture point(unilateral puncture group)and 56 patients were treated using the traditional"2"point and"10"point as the puncture point(bilateral puncture group).The operation time,amount of radiation exposure of patients and surgeons and bone cement injection volume were compared between the two groups.The Cobb angle,height of anterior edge of injured vertebrae,visual analogue scale(VAS)and Oswestry disability index(ODI)were compared before operation,at day 1 after operation and at the final follow-up.Intraoperative and postoperative complications were observed.Results All patients were followed up for 24-35 months[(26.3±4.7)months].The operation time and amount of radiation exposure of patients were(20.4±5.6)minutes and(1.08±0.44)mSv in unilateral puncture group,significantly different from(37.5±9.2)minutes and(2.24±0.58)mSv in bilateral puncture group(all P<0.01).There were no significant differences in amount of radiation exposure of surgeons and bone cement injection volume between the two groups(all P>0.05).In unilateral puncture group and bilateral puncture group,the Cobb angle of fractured vertebrae at day 1 after operation[(22.4±10.7)°,(23.4±11.1)°]and at the final follow-up[(24.3±8.3)°,(23.5±9.5)°]was significantly decreased from that before operation[(29.6±9.7)°,(30.6±12.9)°](all P<0.01);the height of anterior edge of injured vertebrae at day 1 after operation[(80.4±12.6)%,(78.8±11.9)%]and at the final follow-up[(79.3±10.7)%,(77.4±11.2)%]was significantly increased from that before operation[(65.7±6.3)%,(66.4±9.7)%](all P<0.01);the VAS at day 1 after operation[(2.1±0.5)points,(2.3±1.1)points]and at the final follow-up[(1.9±0.8)points,(2.0±0.6)points]was significantly decreased from that before operation[(7.1±0.7)points,(7.2±0.9)points](all P<0.01);the ODI at day 1 after operation(21.1±9.7,22.9±7.9)and at the final follow-up(18.5±4.6,19.8±9.4)was significantly decreased from that before operation(72.7±4.5,73.1±3.7)(all P<0.01).While the above four parameters between the two groups had no significant differences at each time point,with no significant differences within each group at day 1 after operation and at the final follow-up(all P>0.05).There were 13 patients[21%(13/61)]with cement leakage in unilateral puncture group as compared to 18 patients[29%(18/56)]in bilateral puncture group(P<0.05).There were 4 patients[7%(4/61)]with adjacent vertebral fracture in unilateral puncture group,similar to 5 patients[9%(5/56)]in bilateral puncture group(P>0.05).The lower back pain caused by facet injury were noted in 8 patients[14%(8/56)]in bilateral puncture group who were relieved after 1 month of non-surgical treatment,but none occurred in unilateral puncture group(P<0.01).Conclusions Unilateral and bilateral PKP can obtain satisfactory clinical efficacy in the treatment of type IIIA ASOLF,but the former has advantages of shorter operation time,less radiation exposure and lower incidence of bone cement leakage and facet injury.
作者
李大同
安浩
王江
冯明哲
汤志毅
孔令擘
贺宝荣
Li Datong;An Hao;Wang Jiang;Feng Mingzhe;TangZhiyi;Kong Lingbo;He Baorong(Yan′an University Medical School,Yan′an 716099,China;Medical School,Shaanxi University of Chinese Medicine,Xianyang 712046,China;Department of Spinal Surgery,Honghui Hospital of Xi′an Jiaotong University,Xi′an 710054,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2022年第6期523-530,共8页
Chinese Journal of Trauma
基金
陕西省科技成果转移与推广计划-获奖成果转化项目(2018HJCG-08)
陕西省中医药管理局项目(2021-02-ZZ-016)
陕西省卫生健康委员会项目(2022A004)
西安市科技局项目(21YXYJ0024)。
