改良单侧与双侧穿刺腰椎体成形术比较
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李涛,主治医生,研究方向:脊柱外科,(电话)13349834571,(电子信箱)767098776@qq.com

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R687

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湖北陈孝平科技发展基金会资助项目(编号:CXPJJH12000005-07-10);武汉市临床医学科研项目(编号:WX20D19;WZ20D08)


Comparison of modified unilateral puncture versus bilateral counterpart in percutaneous vertebroplasty for osteoporotic lumbar compression fracture
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    摘要:

    目的]对比改良单侧穿刺与双侧椎弓根入路椎体成形术(percutaneous vertebroplasty, PVP)治疗腰椎骨质疏松性压缩性骨折 (osteoporotic vertebral compression fracture, OVCF) 的临床疗效。[方法] 2020 年 6 月—2020 年 12 月,86 例腰椎 OVCF 患者接受 PVP 手术,依据医患沟通结果,51 例采用经椎体后上缘入路单侧穿刺(单侧组),35 例采用常规双侧穿刺(双侧组),比较两组围手术期、随访及影像结果。[结果] 两组患者均顺利完成手术,骨水泥渗漏单侧组有 18 例,双侧组有 13 例,均无严重并发症发生。单侧组术中 X 线曝光次数、住院费用均显著优于双侧组(P<0.05),但前者手术时间显著长于后者 (P<0.05),两组骨水泥注入量、骨水泥分布、骨水泥渗漏、术后下地时间、住院时间、早期 VAS 评分方面的差异均无统计学意义 (P>0.05)。两组患者均获随访 13~24 个月,平均 (15.8±2.1) 个月。随时间推移,两组 VAS 和 ODI 评分显著减少 (P< 0.05),而 JOA 评分显著增加 (P<0.05);相应时间点,两组 VAS、ODI 和 JOA 评分的差异均无统计学意义 (P>0.05)。影像方面,与术前相比,术后两组伤椎前缘高度显著增加 (P<0.05),局部 Cobb 角显著减小 (P<0.05)。相应时间点,两组间伤椎前缘高度、局部 Cobb 角的差异均无统计学意义(P>0.05)。[结论]改良单侧穿刺 PVP 治疗腰椎 OVCF 可获得满意疗效,且具有优化手术流程、节省费用等优势,但具有一定的学习曲线。

    Abstract:

    [Objective] To compare the clinical outcomes of modified unilateral percutaneous vertebroplasty (PVP) versus bilateral PVP for osteoporotic vertebral compression fracture (OVCF) . [Methods] From June 2020 to December 2020, 86 patients underwent PVP for lumbar OVCF. According to doctor-patient communication, 51 patients received unilateral puncture via posterior upper margin of the vertebral body (unilateral group), while the other 35 patients received conventional bilateral puncture (bilateral group) . The perioperative period, follow-up and imaging consequences of the two groups were compared. [Results] All patients in both groups had operation complet- ed successfully, with bone cement leakage in 18 cases of the unilateral group, whereas 13 cases in bilateral group, without serious complica- tions. The unilateral group proved significantly superior to the bilateral group in terms of number of X- ray exposures and hospitalization costs (P<0.05) , however, the former consumed significantly longer operative time than the latter (P<0.05) , and there were no significant dif- ferences in bone cement injection amount, bone cement distribution, bone cement leakage, postoperative ambulation time, hospital stay and early VAS score between the two groups (P>0.05) . During the follow-up lasted for 13~24 months, with an average of (15.8±2.1) months, the VAS scores and ODI decreased significantly (P<0.05) , while JOA score increased significantly in both groups (P<0.05) , and there were no significant differences in VAS, ODI and JOA scores between the two groups at any corresponding time points (P>0.05) . Radiographical- ly, the anterior height of injured vertebrae increased significantly (P<0.05) , whereas the local kyphotic Cobb angle decreased significantly in both groups postoperatively compared with those preoperatively (P<0.05) , which proved not statistically significant between the two groups at any corresponding time points (P>0.05) . [Conclusion] This modified unilateral puncture in PVP does achieve satisfactory clini- cal outcomes for lumbar OVCF, with advantages of optimizing surgical procedure and saving costs, despite of certain learning curve.

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李涛,胡胜利,吉璐宏,等. 改良单侧与双侧穿刺腰椎体成形术比较[J]. 中国矫形外科杂志, 2023, 31 (4): 320-324. DOI:10.3977/j. issn.1005-8478.2023.04.07.
LI Tao, HU Sheng-li, JI Lu-hong, et al. Comparison of modified unilateral puncture versus bilateral counterpart in percutaneous vertebroplasty for osteoporotic lumbar compression fracture[J]. ORTHOPEDIC JOURNAL OF CHINA , 2023, 31 (4): 320-324. DOI:10.3977/j. issn.1005-8478.2023.04.07.

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  • 收稿日期:2022-01-23
  • 最后修改日期:2022-09-08
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  • 在线发布日期: 2023-03-03
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