单球囊单、双侧扩张经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折的比较  

The clinical comparison of unilateral and bilateral dilatation percutaneous kyphoplasty with single balloon for treatment of osteoporotic vertebral compression fractures

作　　者：杨建平[1] 谢国华[1] 薛峰[1] 陆根华[1] 牟晓峰[1] 

机构地区：[1]江苏省常州市中医医院,江苏常州213000

出　　处：《中医正骨》2014年第3期21-24,29,共5页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的：比较单球囊单、双侧扩张经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折的临床疗效和安全性.方法：回顾性分析接受单球囊扩张经皮椎体后凸成形术治疗的44例骨质疏松性椎体压缩骨折患者的病例资料,男9例,女35例;年龄61 ～89岁,中位数72岁;均为单节段椎体压缩骨折;骨折部位,T102例、T116例、T1214例、L115例、L26例、L31例;单侧扩张22例,双侧扩张22例.对2组手术时间、X线曝光次数、骨水泥注入量、骨水泥渗漏率、疼痛视觉模拟评分、伤椎前缘高度丢失百分比、伤椎中部高度丢失百分比、Cobb角进行比较.结果：2组患者均顺利完成手术,单侧经皮椎体后凸成形术组较双侧经皮椎体后凸成形术组手术时间短、X线曝光次数少、骨水泥注入量少[（32.60±9.51）min,（49.70±10.87） min,t=3.742,P=0.002;（15.50±8.37）次,（25.70 ±9.87）次,t=2.982,P=0.008;（3.38±0.83） mL,（6.01±1.21）mL;t =5.664,P=0.000].术后X线及CT检查显示,双侧经皮椎体后凸成形术组骨水泥呈团块状分布于伤椎两侧或均匀弥散,单侧经皮椎体后凸成形术组骨水泥偏一侧呈团块状分布或越过中线弥散分布.2组患者均获随访,随访时间8 ～18个月,中位数11.5个月;骨折均愈合,愈合时间3～6个月,中位数4.5个月.术前2组患者疼痛视觉模拟评分、伤椎前缘高度丢失百分比、伤椎中部高度丢失百分比及Cobb角的组间差异均无统计学意义[（8.518±1.921）分,（8.786±1.580）分;t=0.505,P=0.616;（29.727 ±4.524）％,（30.261±4.192）％;t=0.406,P=0.687;（24.750±3.872）％,（25.022 ±4.682）％;t =0.210,P=0.835;24.543°±4.021°,25.121°±3.954°;t =0.481,P=0.633].术后1d,2组患者疼痛缓解,疼痛视觉模拟评分均较术前降低（t=25.561,P=0.000;t=35.927,P=0.000）;伤椎前缘高度丢失百分比、伤椎中部高度丢失百分比及Cobb角均较术前减小（t=42.400,P=0.000;t=38.572,P=0.000;t=47.929,P=0.000;t=27.563,PObjective ： To compare the clinical curative effect and safety of unilateral versus bilateral dilatation percutaneous kyphoplas- ty （PKP）with single balloon for treatment of osteoporotic vertebral compression fractures （OVCF）. Methods：The medical records of 44 pa- tients with single - segment OVCF treated with single balloon PKP were analyzed retrospectively. The patients consisted of 9 males and 35 females ,and ranged in age from 61 to 89 years（ Mean = 72 yrs）. The fractures located in Ti0 （2） ,Tll （6） ,T12 （14） ,L1 （15） ,L2 （6）and L3 （ 1 ）. Unilateral dilatation PKP was performed in 22 patients and bilateral dilatation PKP was performed in 22 patients. Then the two groups were compared with eaeh other in such parameters as operative time, frequency of X-ray exposure, eonsumption of bone cement, incidence rate of bone cement leakage, visual analogue scores （VAS） ,loss of anterior border and middle height of injured vertebrae and kyphosis Cobb angle. Results：The surgery were performed successfully in all the patients and. the unilateral PKP had shorter operative time, fewer X-ray exposure and less consumption of bone cement than did bilateral PKP （ 32.60 ＋/- 9.51 vs 49.70 ＋/- 10.87 rain, t = 3. 742, P = 0. 002 ; 15.50 ＋/- 8.37 vs 25.70 ＋//- 9.87, t =- 2. 982, P = 0. 008 ; 3.38 ＋/- 0.83 vs 6.01 ＋/- 1.21 mL; t = 5. 664, P = O. 000）. Postoperative X-ray and CT examination showed that the bone eements were well-distributed or distributed in clumps in both sides of injured vertebra in bilateral PKP group,while the bone cements were distributed in clumps in one side of injured vertebra or dispersed across the midline in unilateral PKP group. The patients in the 2 groups were all followed up for 8 - 18 months with a median of 11.5 months. All fractures united between 3 and 6 weeks with a median of 4.5 weeks. There was no statistical difference in VAS, percentage of loss of injured vertebrae ante- rior border and middle height of injured vertebrae and kyphosis

关 键 词：脊柱骨折 椎体后凸成形术 骨质疏松性骨折 

分 类 号：R687.3[医药卫生—骨科学]