两种入路经皮弯角椎体成形术治疗骨质疏松性椎体压缩骨折的疗效比较  

Effect comparison of percutaneous curved vertebroplasty via two approaches on osteoporotic vertebral compression fractures

作　　者：兰向宇 蒙永晖 赖少华 LAN Xiang-yu;MENG Yong-hui;LAI Shao-hua(Dept of Orthopaedic Surgery,Hezhou Guangji Hospital,Hezhou,Guangxi 542800,China)

机构地区：[1]贺州广济医院骨外科,广西贺州542800

出　　处：《临床骨科杂志》2025年第1期6-10,共5页Journal of Clinical Orthopaedics

基　　金：广西壮族自治区贺州市科技局科学研究与技术开发计划项目(编号:贺科技202295)。

摘　　要：目的比较后外上方入路与经椎弓根入路经皮弯角椎体成形术(PCVP)治疗骨质疏松性椎体压缩骨折(OVCF)的疗效。方法根据手术入路不同将86例OVCF患者分为A组(采用单侧后外上方入路PCVP治疗,41例)和B组(采用单侧经椎弓根入路PCVP治疗,45例)。比较两组手术情况、骨折愈合情况、疼痛VAS评分、伤椎Cobb角以及并发症发生率。结果患者均获得随访,时间3~6个月。手术时间A组短于B组(P<0.05),骨水泥分布等级A组优于B组(P<0.05),术中透视次数、骨水泥注入量和术后住院时间两组比较差异均无统计学意义(P>0.05)。术后3个月两组骨折均愈合良好。疼痛VAS评分以及伤椎Cobb角:两组术后1周、1个月、3个月均低于术前(P<0.05),两组术后各时间点比较差异均无统计学意义(P>0.05)。骨水泥渗漏发生率A组低于B组(P<0.05),伤椎再骨折、邻近椎体骨折和肋间神经损伤发生率两组比较差异均无统计学意义(P>0.05)。结论后外上方入路与经椎弓根入路PCVP治疗OVCF均能缓解患者疼痛、纠正后凸畸形;后外上方入路手术时间更短,骨水泥分布效果更好,骨水泥渗漏发生率更低。Objective To compare the efficacy of percutaneous curved vertebroplasty(PCVP)with posterolateral-superior approach and transpedicular approach on the osteoporotic vertebral compression fracture(OVCF).Methods According to different surgical approaches,86 patients with OVCFs were divided into group A(41 cases were treated by PCVP with unilateral posterolateral-superior approach),and group B(45 cases were treated by PCVP with unilateral transpedicular appraoch).The operation conditions,fracture healing,pain VAS,Cobb angle of the injured vertebra and complication incidence were compared between the two groups.Results All patients were followed up for 3~6 months.The operative time in group A was shorter than that in group B(P<0.05),and the distribution grade of bone cement in group A was better than that in group B(P<0.05).There were no statistical differences in intraoperative fluoroscopy frequency,the volume of bone cement injection and postoperative hospitalization time between the two groups(P>0.05).At 3 months after operation,all fractures of both groups healed well.Pain VAS and Cobb angle of injured vertebra:They were lower at 1 week,1,3 months after surgery,compared with those before surgery(P<0.05),and there were no statistical significance between the two groups at each time-point after surgery(P>0.05).The incidence of bone cement leakage in group A was lower than that in group B(P<0.05),and there were no statistical differences in the incidence of re-fracture of the injured vertebrae,adjacent vertebral fracture and intercostal nerve injury between two groups(P>0.05).Conclusions Both the posterolateral-superior approach and transpedicular approach undergoing PCVP can relive the patients′pain,corrrect the kyphosis deformity,while posterolateral-superior approach has shorter operation time,better bone cement distribution effect,and lower incidence rate of bone cement leakage.

关 键 词：后外上方入路 经椎弓根入路 经皮弯角椎体成形术 骨质疏松性椎体压缩骨折 骨水泥渗漏 

分 类 号：R683.2[医药卫生—骨科学] R681[医药卫生—外科学] R687.3[医药卫生—临床医学]