经横突-椎弓根外侧入路单侧穿刺双侧球囊扩张椎体成形术治疗腰椎骨质疏松性椎体压缩骨折  

Bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach for osteoporotic vertebral compression fracture of lumbar

作　　者：潘洪 丁舒晨 赵新华 林宗阳 叶虹 倪志明 符楚迪 夏俊杰 PAN Hong;DING Shuchen;ZHAO Xinhua;LIN Zongyang;YE Hong;NI Zhiming;FU Chudi;XIA Junjie(Center of Orthopedics,the 903th Hospital of People's Liberation Army,Hangzhou Zhejiang,310001,P.R.China;The Third Department of Orthopedics,Zhejiang Hospital,Hangzhou Zhejiang,310001,P.R.China)

机构地区：[1]解放军联勤保障部队第九〇三医院骨科中心,杭州310001 [2]浙江医院骨三科,杭州310001

出　　处：《中国修复重建外科杂志》2021年第8期1007-1013,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：杭州市医药卫生科技计划项目(B20200446)。

摘　　要：目的探讨采用经横突-椎弓根外侧入路单侧穿刺双侧球囊扩张经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗腰椎骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)的可行性及近期疗效。方法回顾分析2018年1月—2019年6月符合选择标准的93例腰椎OVCF患者临床资料,根据手术方式不同分为A组(44例,行经横突-椎弓根外侧入路单侧穿刺双侧球囊扩张PKP治疗)和B组(49例,行双侧经椎弓根入路PKP治疗)。两组患者性别、年龄、体质量指数、骨密度T值、致伤原因、损伤节段、受伤至手术时间、合并基础疾病及术前伤椎Cobb角、疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)等一般资料比较差异均无统计学意义(P>0.05)。记录并比较两组患者手术时间、术中透视次数、骨水泥注入量、骨水泥渗漏率;术前、术后2 d及术后1年伤椎Cobb角、VAS评分和ODI。根据术后2 d正位X线片计算骨水泥对侧分布率。结果A组手术时间、术中透视次数均显著少于B组(P<0.05)。两组患者术中、术后均无骨水泥不良反应及心、脑血管不良事件发生,无穿刺针误入椎管及神经损伤等并发症。A、B组分别有6例和8例发生骨水泥渗漏,均为无症状性椎旁或椎间隙渗漏,无椎管内渗漏发生;两组骨水泥注入量及骨水泥渗漏率比较差异均无统计学意义(P>0.05)。A组骨水泥对侧分布率显著低于B组(t=2.685,P=0.009)。两组患者均获随访,随访时间12~20个月,平均15.3个月。两组术后2 d伤椎Cobb角、VAS评分和ODI均较术前显著改善,但术后1年伤椎Cobb角较术后2 d有显著复位丢失,VAS评分和ODI较术后2 d进一步改善,差异均有统计学意义(P<0.05);术后各时间点两组间伤椎Cobb角、VAS评分和ODI比较差异均无统计学意义(P>0.05)。结论与双侧入路PKP比较,经横突-椎弓根外侧入路单侧穿刺双侧球囊扩张PKP在骨折复位、复位维持、疼痛缓�Objective To evaluate the feasibility and short-term effectiveness of bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach for osteoporotic vertebral compression fracture(OVCF)of lumbar.Methods A retrospective analysis was made on the clinical data of 93 patients with OVCF of lumbar who met the selection criteria between January 2018 and June 2019.According to the different surgical methods,they were divided into group A(44 cases,treated with bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach)and group B[49 cases,treated with percutaneous kyphoplasty(PKP)via bilateral transpedicle approach].There was no significant difference in gender,age,body mass index,T value of bone mineral density,injury cause,fractured level,time from injury to operation,comorbidities,and preoperative Cobb angle of injured vertebra,visual analogue scale(VAS)score,and Oswestry disability index(ODI)between the two groups(P>0.05).The operation time,intraoperative fluoroscopy times,bone cement injection amount,and incidence of bone cement leakage were recorded and compared between the two groups;Cobb angle of the injured vertebrae,VAS score,and ODI were measured before operation,at 2 days and 1 year after operation.The contralateral distribution ratio of bone cement was calculated according to the anteroposterior X-ray film at 2 days after operation.Results The operation time and the intraoperative fluoroscopy times in group A were significantly less than those in group B(P<0.05).There was no bone cement adverse reactions,cardiac and cerebrovascular adverse events,and no complications such as puncture needles erroneously inserted into the spinal canal and nerve injuries occurred in the two groups.Bone cement leakage occurred in6 cases and 8 cases in groups A and B,respectively,all of which were asymptomatic paravertebral or intervertebral leakage,and no intraspinal leakage occurred;the bone cement injection amount and incidence of bone cem

关 键 词：骨质疏松性椎体压缩骨折 经皮椎体后凸成形术 脊柱骨折 脊椎穿刺 

分 类 号：R687.3[医药卫生—骨科学]