单双侧液压输送高粘度骨水泥椎体成形术治疗骨质疏松性椎体压缩性骨折疗效分析  

The clinical outcomes of the unilateral and bilateral hydraulic delivery vertebroplasty with high viscosity bone cement for osteoporotic vertebral compression fractures

作　　者：陈斌伟[1] 杨进顺[1] 郭剑鸿[1] 刘圣曜 谢楚海[1] CHEN Bin-wei;YANG Jin-shun;GUO Jian-hong;LIU Sheng-yao;XIE Chu-hai(Department of Orthopaedics,The Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510260,Guangdong,China)

机构地区：[1]广州医科大学附属第二医院骨外科,广东广州510260

出　　处：《广东医学》2019年第7期941-946,共6页Guangdong Medical Journal

基　　金：广东省医学科研基金资助项目(编号:B2017094)

摘　　要：目的探讨单双侧液压输送高粘度骨水泥经皮椎体成形术在治疗骨质疏松性椎体压缩性骨折的临床疗效。方法随机选取诊断为单椎体骨质疏松性胸腰椎压缩性骨折的患者60例,按照单双侧液压输送高粘度骨水泥椎体成形术分为单侧组和双侧组各30例,比较两组病例手术时间、术中X线透视次数、骨水泥注入量,术前术后伤椎椎体高度、椎体Cobb角、视觉模拟VAS评分、功能障碍指数(ODI)等指标。结果两组患者均未出现骨水泥渗漏引起的神经症状并发症,单侧组的手术时间、术中透视次数和骨水泥注入量均明显少于双侧组,差异均有统计学意义(P<0.05);双侧组术后伤椎椎体前缘、中间高度均较术前改善,差异有统计学意义(P<0.05),单侧组术后伤椎椎体前缘、中间高度较术前改善不大,差异无统计学意义(P>0.05);单双侧组椎体Cobb角术后较术前的差异有统计学意义(P<0.05);两组术后1 d、半年VAS评分及ODI评分均较术前明显改善,差异有统计学意义(P<0.05),单双侧两组之间的VAS评分及ODI指数在术前、术后1 d及术后半年随访之间的比较均差异无统计学意义。结论单双侧液压输送高粘度骨水泥椎体成形术治疗骨质疏松性椎体压缩性骨折,骨水泥弥散满意,临床效果满意。单侧经皮椎体成形术手术时间短、术中辐射量少,但双侧经皮椎体成形术改善椎体高度较理想,具体根据患者年龄选择不同手术方案。Objective To investigate the clinical outcomes of the unilateral and bilateral hydraulic delivery vertebroplasty with high viscosity bone cement for osteoporotic vertebral compression fractures.Methods Sixty patients with single osteoporotic vertebral compression fracture in our hospital from June 2014 to Apr 2017 were randomly divided into 2 groups.Unilateral hydraulic delivery percutaneous vertebroplasty(HDPVP)and bilateral HDPVP with high viscosity bone cement were performed in the 2 groups.The preoperative and postoperative visual analog scales(VAS),Oswestry disability index(ODI),operative time,intraoperative fluoroscopy times,the amount of bone cement injection,vertebral heights before and after treatment,and kyphosis(Cobb angle)were compared.Results Both groups were successfully treated without neurological complication of bone cement leakage.The operative time,intraoperative fluoroscopy times and the amount of bone cement injection in the unilateral group were significantly less than those in the bilateral group(P<0.05).There was no significant improvement in anterior or medial vertebral height after treatment in the unilateral group(P>0.05);while they were significantly improved in the bilateral group(P<0.05).The postoperative kyphosis(Cobb angle)of both the 2 groups were significantly improved(P<0.05).The postoperative VAS and ODI of the 2 groups were significantly improved between one day and half an year after operation(P<0.05);but there was no significant difference between the 2 groups.Conclusion Both unilateral and bilateral HDPVP with high viscosity bone cement are good for osteoporotic vertebral compression fractures,which significantly relieve pain and improve function of life.The unilateral HDPVP with high viscosity bone cement is simpler surgical procedure,with shorter operative time,less intraoperative fluoroscopy,less bone cement leakage rate.But the bilateral treatment can improve the anterior vertebral height.The surgical choice depends on the age of the patients.

关 键 词：经皮椎体成形术 骨质疏松性椎体压缩性骨折 后凸成形术 

分 类 号：R687.3[医药卫生—骨科学] R602[医药卫生—外科学]