单侧入路与双侧入路球囊扩张椎体后凸成形术治疗老年人新鲜椎体骨质疏松性压缩骨折疗效差异研究  

Comparison of curative effect between unilateral approach and bilateral approach balloon-expandable kyphoplasty in the treatment of osteoporotic compression fractures of fresh vertebral body in the elderly

作　　者：吴文明 张强[1] WU Wen-ming;ZHANG Qiang(Department of Orthopaedics, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China)

机构地区：[1]首都医科大学附属北京地坛医院骨科,北京100015

出　　处：《广西大学学报（自然科学版）》2020年第4期848-852,共5页Journal of Guangxi University（Natural Science Edition）

基　　金：国家自然科学基金资助项目(81600147)。

摘　　要：研究单侧入路与双侧入路球囊扩张椎体后凸成形术治疗老年人新鲜椎体骨质疏松性压缩骨折疗效差异。选取2015年10月至2018年10月在本院接受治疗的胸腰部椎体压缩性骨折老年患者共300例,均为单一性椎体骨折,将其随机分成2组,单侧入路组(150例),双侧入路组(150例),观察患者X线暴露时间、手术时间、骨水泥填充量、术中出血量及透视次数状况;术前、术后72 h及术后6 m拍摄患者脊柱正位和侧位X线片,并在侧位X片上测量手术前后椎体前缘和中部高度的变化情况,ELISA法检测血清骨钙素(BGP)、Ⅰ型前胶原氨基端前肽(PINP)及碱性磷酸酶(ALP)含量。单侧入路组患者X线暴露时间、手术时间、骨水泥填充量、术中出血量及透视次数均低于对照组,差异有统计学意义(P<0.05);术后72 h及6 m两组患者伤椎体前缘及中部高度较术前显著升高,差异有统计学意义(P<0.05),术前术后两组对比差异均无统计学意义(P<0.05);单侧入路组患者术后3 d血清BGP、ALP较术前、双侧入路组显著升高,PINP含量较术前、双侧入路组显著降低,差异均有统计学意义(P<0.05)。单、双侧入路椎体后凸成形手术对于治疗老年椎体骨质疏松性压缩骨折疗效近似,但单侧入路椎体后凸成形手术可以大大缩短手术时间、降低透视次数及骨水泥填充量,增大成骨细胞活性,使患者骨密度增大。The aim of this research is to compare therapeutic effects of unilateral approach and bilateral approach kyphoplasty in the treatment of vertebral osteoporotic compression fractures in the elderly.A total of 300 elderly patients with thoracic and lumbar vertebral compression fractures who were treated in our hospital from October 2015 to October 2018 were selected and they were all with single vertebral fractures.They were randomly divided into 2 groups,unilateral approach group(150 cases)and bilateral approach group(150 cases).X-ray exposure time,operation time,bone cement filling volume,intraoperative blood loss and fluoroscopy frequency were observed;preoperative,postoperative 72 hours and postoperative 6 monthly radiographs of the patient's spine were taken on the anteroposterior and lateral radiographs.Changes in vertebral body anterior and medial heights before and after surgery were measured on lateral radiographs.Serum osteocalcin(BGP)and type I procollagen amino acids were measured by ELISA.Propeptide(PINP)and alkaline phosphatase(ALP)content.The X-ray exposure time,operation time,bone cement filling volume,intraoperative blood loss and fluoroscopy times were lower in the unilateral approach group than in the control group(P<0.05);72 hours and 6 postoperative days.The heights of the anterior and middle vertebral bodies in the two groups were significantly higher than those before surgery in both groups(P<0.05).There was no significant difference between the two groups before and after surgery(P<0.05).Serum BGP and ALP levels in the lateral approach group were significantly higher than those in the preoperative and bilateral approach groups at the 3rd postoperative day,and PINP levels were significantly lower than those in the preoperative and bilateral approach groups(P<0.05).Single and double approach kyphoplasty is similar to the treatment of vertebral osteoporotic compression fractures in the elderly,but unilateral approach kyphoplasty can greatly shorten the operation time,reduce the number of perspe

关 键 词：骨质疏松 椎体后凸成形术 椎体骨折 

分 类 号：R684.3[医药卫生—骨科学]