单、双侧椎弓根入路及单侧椎弓根外入路椎体成形治疗胸腰段椎体压缩性骨折:骨水泥灌注量与渗漏率  

Percutaneous vertebroplasty through unilateral and bilateral pedicle approaches and unilateral pedicle extrapedicle approach for the treatment of thoracolumbar vertebral compression fractures:bone cement perfusion volume and cement leakage rate

作　　者：张志伟[1] 李利 黄兹谕[1] 吴多艺[1] 甘发荣[1] 叶宝飞[1] 张岩[1] 张泰标[1] 胡万钧[1] Zhang Zhiwei;Li Li;Huang Ziyu;Wu Duoyi;Gan Farong;Ye Baofei;Zhang Yan;Zhang Taibiao;Hu Wanjun(Department of Orthopedics,Hainan Provincial Hospital of Traditional Chinese Medicine,Haikou 570203,Hainan Provinee,China)

机构地区：[1]海南省中医院骨科

出　　处：《中国组织工程研究》2020年第9期1353-1358,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:临床上椎体成形骨水泥注射的入路方式主要有单侧椎弓根入路、双侧椎弓根入路、单侧椎弓根外入路,但对于3种入路方式的临床疗效、并发症等情况对比仍存在争议。目的:对比3种入路椎体成形骨水泥注射治疗胸腰段椎体压缩性骨折的临床疗效。方法:纳入2016年1月至2018年1月海南省中医院收治的胸腰段椎体压缩性骨折患者78例,其中男30例,女48例,年龄40-71岁。其中20例采用单侧椎弓根入路进行椎体成形骨水泥注射治疗,35例采用双侧椎弓根入路进行椎体成形骨水泥注射治疗,23例采用单侧椎弓根外入路进行椎体成形骨水泥注射治疗,记录骨水泥灌注量与骨水泥渗漏率。术后随访1年,对比3组目测类比评分、Oswestry功能障碍指数评分、椎体高度重建率、Cobb角改善、患者满意度及并发症发生情况。试验获得海南省中医院伦理委员会批准,批准号:伦审HKL20151203。结果与结论:①双侧椎弓根组骨水泥灌注量少于单侧椎弓根组、单侧椎弓根外组(P<0.05),单侧椎弓根外组少于单侧椎弓根组(P<0.05);②3组间椎体高度重建率、Cobb角改善及患者满意度比较差异均无显著性意义(P>0.05);3组术后随访1年的目测类比评分、Oswestry功能障碍指数评分均较术前明显改善(P<0.05);③双侧椎弓根组骨水泥渗漏率低于单侧椎弓根组、单侧椎弓根外组(P<0.05),单侧椎弓根外组低于单侧椎弓根组(P<0.05):④双侧椎弓根组邻近椎体骨折率低于单侧椎根组(P<0.05);⑤结果表明,3种入路椎体成形骨水泥注射治疗胸腰段椎体压缩性骨折均能取得较好的临床疗效,双侧椎弓根入路可显著降低骨水泥渗漏及邻近椎体骨折发生率。BACKGROUND:Percutaneous vertebroplasty is clinically performed mainly through unilateral and bilateral pedicle approaches and unilateral pedicle extrapedicle approach.However,there are still disputes on the clinical effect and complications of the three approaches.OBJECTIVE:To compare the clinical effect of percutaneous vertebroplasty in the treatment of thoracolumbar vertebral compression fractures among three approaches.METHODS:Seventy-eight patients with thoracolumbar vertebral compression fractures who received treatment in Hainan Provincial Hospital of Traditional Chinese Medicine,China between January 2016 and January 2018 were included in this study.These patients consisted of 30 males and 48 females and were aged 40-71 years.Twenty patients received bone cement perfusion through the unilateral pedicle approach(unilateral pedicle group),35 patients received bone cement perfusion through the bilateral pedicle approach(bilateral pedicle group),and 23 patients received bone cement perfusion through the unilateral pedicle extrapedicle approach(unilateral pedicle extrapedicle group).Bone cement perfusion volume and cement leakage rate were recorded.All patients were followed up for 1 year.The Visual Analogue Scale score,Oswestry Disability Index,vertebral height reconstruction rate,Cobb angle improvement,patient satisfaction and complications were compared among the three groups.This study was approved by the Hospital Ethics Committee,Hainan Provincial Hospital of Traditional Chinese Medicine,China(approval No.HKL20151203).RESULTS AND CONCLUSION:(1) Bone cement perfusion volume in the bilateral pedicle group was significantly lower than that in the unilateral pedicle and unilateral pedicle extrapedicle groups(P <0.05).Bone cement perfusion volume in the unilateral pedicle extrapedicle group was significantly lower than that in the unilateral pedicle group(P <0.05).(2) There were no significant differences in vertebral height reconstruction rate,Cobb angle improvement and patient satisfaction among the three gro

关 键 词：压缩性骨折 骨水泥 经皮椎体成形 单侧椎弓根入路 双侧椎弓根入路 单侧椎弓根外入路 骨水泥渗漏 邻近椎体骨折发生率 

分 类 号：R459.9[医药卫生—治疗学] R687.42[医药卫生—临床医学]