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。
[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).Radiographically,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 clinical out⁃comes for lumbar OVCF,with advantages of optimizing surgical procedure and saving costs,despite of certain learning curve.
作者
李涛
胡胜利
吉璐宏
朱凌
LI Tao;HU Sheng-li;JI Lu-hong;ZHU Ling(Hubei 672 Orthopedic Hospital of Integrated Traditional Chinese and Western Medicine,Wuhan430079,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2023年第4期320-324,共5页
Orthopedic Journal of China
基金
湖北陈孝平科技发展基金会资助项目(编号:CXPJJH12000005-07-10)
武汉市临床医学科研项目(编号:WX20D19
WZ20D08)。
关键词
骨质疏松
腰椎压缩性骨折
椎体强化术
椎体成形术
osteoporosis
lumbar osteoporotic compression fracture
vertebral augmentation
vertebroplasty
