经横突中点⁃关节突移行部入路与经单侧椎弓根入路经皮椎体成形术治疗骨质疏松性腰椎压缩骨折的疗效比较  

Efficacy comparison of percutaneous vertebroplasty in the treatment of osteoporotic lumbar compression fracture via the approach through midpoint transverse process‑transition zone of articular process and the unilateral transpedicular approach

作　　者：王江 都金鹏[2] 李帅 王晓辉[2] 黄云飞[2] 冯铭哲[1,2] 屈泽超 汤志毅 贺宝荣 Wang Jiang;Du Jinpeng;Li Shuai;Wang Xiaohui;Huang Yunfei;Feng Mingzhe;Qu Zechao;Tang Zhiyi;He Baorong(Yan′an University School of Medicine,Yan′an 716099,China;Department of Spine Surgery,Honghui Hospital Affiliated to Xi′an Jiaotong University,Xi′an 710054,China;Shaanxi University of Traditional Chinese Medicine School of Medicine,Xianyang 712046,China)

机构地区：[1]延安大学医学院,延安716099 [2]西安交通大学附属红会医院脊柱外科,西安710054 [3]陕西中医药大学医学院,咸阳712046

出　　处：《中华创伤杂志》2023年第5期427-434,共8页Chinese Journal of Trauma

摘　　要：目的比较经横突中点⁃关节突移行部入路和经单侧椎弓根入路经皮椎体成形术(PVP)治疗骨质疏松性腰椎压缩骨折(OLCF)的疗效。方法采用前瞻性队列研究分析2017年1月至2019年12月西安交通大学附属红会医院收治的794例OLCF患者临床资料。采用信封法将患者随机分为移行部穿刺组(400例,400个椎体)和椎弓根穿刺组(394例,394个椎体),其中移行部穿刺组采用经横突中点⁃关节突移行部入路PVP,椎弓根穿刺组采用经单侧椎弓根入路PVP。比较两组手术时间、辐射剂量、术前、术后1 d、术后3个月及术后1年视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)。比较两组骨水泥椎体分布情况;比较两组骨水泥渗漏、伤椎再骨折、脊髓神经损伤、小关节损伤等并发症发生率。结果共纳入患者男270例,女524例;年龄68.9~78.5岁[(73.7±4.8)岁]。患者均获随访12~14个月[(13.4±0.8)个月]。移行部穿刺组手术时间和辐射剂量短于或小于椎弓根穿刺组(P均<0.01)。两组术前VAS、ODI差异无统计学意义(P均>0.05)。移行部穿刺组术后1 d、术后3个月和术后1年VAS分别为(2.1±0.9)分、(2.3±1.1)分、(2.7±1.3)分,椎弓根穿刺组分别为(2.3±0.7)分、(2.5±0.9)分、(2.9±1.1)分,两组术后较术前明显降低(P均<0.01),术后两组间差异有统计学意义(P<0.05或0.01)。移行部穿刺组术后1 d、术后3个月及术后1年ODI分别为14.3±1.8、13.6±3.4、11.3±4.4,椎弓根穿刺组分别为25.5±5.7、20.7±6.3、20.6±6.9,两组术后较术前明显降低(P均<0.01),术后两组间差异有统计学意义(P均<0.01)。移行部穿刺组的双侧骨水泥分布椎体个数(324个)多于椎弓根穿刺组(94个)(P<0.01)。移行部穿刺组骨水泥渗漏发生率、伤椎再骨折发生率、小关节损伤发生率分别为8.25%(33/400)、0.00%(0/400)、3.25%(13/400),低于椎弓根穿刺组的20.81%(82/394)、2.03%(8/394)、9.90%(39/394)(P<0.05或0.01),两组神经损伤发生�Objective To compare the efficacy of percutaneous vertebroplasty(PVP)in the treatment of osteoporotic lumbar compression fracture(OLCF)via the approach through midpoint transverse process⁃transition zone of articular process and the unilateral transpedicular approach.Methods A prospective cohort study was conducted to analyze the clinical data of 794 patients with OLCF treated in Honghui Hospital affiliated to Xi′an Jiaotong University School of Medicine from January 2017 to December 2019.The patients were divided into transitional-zone puncture group(400 patients,400 vertebrae)and pedicle puncture group(394 patients,394 vertebrae)according to the envelope method.The transitional-zone puncture group was treated with PVP via the approach through midpoint transverse process⁃transition zone of articular process,and the pedicle puncture group was treated with PVP via the unilateral transpedicular approach.The operation time and radiation dose were documented.The visual analogue score(VAS)and Oswestry dysfunction index(ODI)were evaluated before operation and at 1 day,3 months,1 year after operation.The cement distribution and the incidence of complications such as cement leakage,re⁃fracture of the injured vertebra,spinal cord nerve injury and facet joint injury were detected.Results The patients were composed of 270 males and 524 females,at the age of 68.9-78.5 years[(73.7±4.8)years].All patients were followed up for 12⁃14 months[(13.4±0.8)months].The operation time and radiation dose in transitional-zone puncture group were reduced compared with pedicle puncture group(P<0.01).There was no significant difference in VAS and ODI between the two groups before operation(all P>0.05).The VAS between transitional-zone puncture group[(2.1±0.9)points,(2.3±1.1)points,(2.7±1.3)points]and pedicle puncture group[(2.3±0.7)points,(2.5±0.9)points,(2.9±1.1)points]was obviously reduced from that before operation(all P<0.01),significantly different at 1 day,3 months,1 year after operation(P<0.05 or 0.01).The ODI betwee

关 键 词：骨质疏松症 腰椎骨折 椎体成形术 小关节损伤 

分 类 号：R687.3[医药卫生—骨科学]