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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:

第26卷

期數(shù):

2014年03期

頁碼:

21-24

欄目:

脊柱微創(chuàng)技術(shù)

出版日期:

2014-03-30

文章信息/Info

Title:

The clinical comparison of unilateral and bilateral dilatation percutaneous kyphoplasty with single balloon for treatment of osteoporotic vertebral compression fractures

作者:

楊建平; 謝國華; 薛峰; 陸根華; 牟曉峰

江蘇省常州市中醫(yī)醫(yī)院,江蘇 常州 213000

Author(s):

Yang Jianping^*; Xie Guohua; Xue Feng; Lu Genhua; Mou Xiaofeng.

^*Changzhou Hospital of Traditional Chinese Medicine,Changzhou 213000,Jiangsu,China

關(guān)鍵詞:

脊柱骨折 椎體后凸成形術(shù) 骨質(zhì)疏松性骨折

Keywords:

Spinal fractures;  Kyphoplasty;  Osteoporotic fractures

摘要:

目的:比較單球囊單、雙側(cè)擴張經(jīng)皮椎體后凸成形術(shù)治療骨質(zhì)疏松性椎體壓縮骨折的臨床療效和安全性。方法:回顧性分析接受單球囊擴張經(jīng)皮椎體后凸成形術(shù)治療的44例骨質(zhì)疏松性椎體壓縮骨折患者的病例資料,男9例,女35例; 年齡61～89歲,中位數(shù)72歲; 均為單節(jié)段椎體壓縮骨折; 骨折部位,T₁₀2例、T₁₁6例、T₁₂14例、L₁15例、L₂6例、L₃1例; 單側(cè)擴張22例,雙側(cè)擴張22例。對2組手術(shù)時間、X線曝光次數(shù)、骨水泥注入量、骨水泥滲漏率、疼痛視覺模擬評分、傷椎前緣高度丟失百分比、傷椎中部高度丟失百分比、Cobb角進(jìn)行比較。結(jié)果:2組患者均順利完成手術(shù),單側(cè)經(jīng)皮椎體后凸成形術(shù)組較雙側(cè)經(jīng)皮椎體后凸成形術(shù)組手術(shù)時間短、X線曝光次數(shù)少、骨水泥注入量少[(32.60±9.51)min,(49.70±10.87)min,t=3.742,P=0.002;(15.50±8.37)次,(25.70±9.87)次,t=2.982,P=0.008;(3.38±0.83)mL,(6.01±1.21)mL; t=5.664,P=0.000]。術(shù)后X線及CT檢查顯示,雙側(cè)經(jīng)皮椎體后凸成形術(shù)組骨水泥呈團(tuán)塊狀分布于傷椎兩側(cè)或均勻彌散,單側(cè)經(jīng)皮椎體后凸成形術(shù)組骨水泥偏一側(cè)呈團(tuán)塊狀分布或越過中線彌散分布。2組患者均獲隨訪,隨訪時間8～18個月,中位數(shù)11.5個月; 骨折均愈合,愈合時間3～6個月,中位數(shù)4.5個月。術(shù)前2組患者疼痛視覺模擬評分、傷椎前緣高度丟失百分比、傷椎中部高度丟失百分比及Cobb角的組間差異均無統(tǒng)計學(xué)意義[(8.518±1.921)分,(8.786±1.580)分; t=0.505,P=0.616;(29.727±4.524)%,(30.261±4.192)%; t=0.406,P=0.687;(24.750±3.872)%,(25.022±4.682)%; t=0.210,P=0.835; 24.543°±4.021°,25.121°±3.954°; t=0.481,P=0.633]。術(shù)后1 d,2組患者疼痛緩解,疼痛視覺模擬評分均較術(shù)前降低(t=25.561,P=0.000; t=35.927,P=0.000); 傷椎前緣高度丟失百分比、傷椎中部高度丟失百分比及Cobb角均較術(shù)前減小(t=42.400,P=0.000; t=38.572,P=0.000; t=47.929,P=0.000; t=27.563,P=0.000; t=38.627,P=0.000; t=31.531,P=0.000); 但2組間以上各項療效評價指標(biāo)比較,差異均無統(tǒng)計學(xué)意義[(2.886±1.205)分,(2.846±1.137)分; t=0.113,P=0.910;(11.546±2.903)%,(10.983±3.439)%; t=0.587,P=0.561;(10.159±2.648)%,(9.637±2.371)%; t=0.688,P=0.495; 9.872°±2.361°,9.214°±1.859°; t=1.027,P=0.310]。單側(cè)經(jīng)皮椎體后凸成形組術(shù)后并發(fā)骨水泥滲漏3例,雙側(cè)經(jīng)皮椎體后凸成形組術(shù)后并發(fā)骨水泥滲漏2例,均無神經(jīng)脊髓損傷、肺栓塞等并發(fā)癥發(fā)生,未予特殊處理; 2組患者骨水泥滲漏發(fā)生率比較,差異無統(tǒng)計學(xué)意義(χ2=0.000,P=1.000)。結(jié)論:單球囊單、雙側(cè)擴張經(jīng)皮椎體后凸成形術(shù)治療骨質(zhì)疏松性椎體壓縮骨折均能有效緩解疼痛、恢復(fù)傷椎高度、糾正脊柱畸形,療效相當(dāng),并發(fā)癥少。但單側(cè)擴張手術(shù)時間更短、X線曝光次數(shù)及骨水泥注入量更少,更適合于高齡體弱難以耐受長時間俯臥的患者。

Abstract:

Objective:To compare the clinical curative effect and safety of unilateral versus bilateral dilatation percutaneous kyphoplasty(PKP)with single balloon for treatment of osteoporotic vertebral compression fractures(OVCF).Methods:The medical records of 44 patients with single-segment OVCF treated with single balloon PKP were analyzed retrospectively.The patients consisted of 9 males and 35 females,and ranged in age from 61 to 89 years(Mean=72 yrs).The fractures located in T₁₀(2),T₁₁(6),T₁₂(14),L₁(15),L₂(6)and L₃(1).Unilateral dilatation PKP was performed in 22 patients and bilateral dilatation PKP was performed in 22 patients.Then the two groups were compared with each other in such parameters as operative time,frequency of X-ray exposure,consumption of bone cement,incidence rate of bone cement leakage,visual analogue scores(VAS),loss of anterior border and middle height of injured vertebrae and kyphosis Cobb angle.Results:The surgery were performed successfully in all the patients and.the unilateral PKP had shorter operative time,fewer X-ray exposure and less consumption of bone cement than did bilateral PKP(32.60+/-9.51 vs 49.70+/-10.87 min,t=3.742,P=0.002; 15.50+/-8.37 vs 25.70+/-9.87,t=2.982,P=0.008; 3.38+/-0.83 vs 6.01+/-1.21 mL; t=5.664,P=0.000).Postoperative X-ray and CT examination showed that the bone cements were well-distributed or distributed in clumps in both sides of injured vertebra in bilateral PKP group,while the bone cements were distributed in clumps in one side of injured vertebra or dispersed across the midline in unilateral PKP group.The patients in the 2 groups were all followed up for 8-18 months with a median of 11.5 months.All fractures united between 3 and 6 weeks with a median of 4.5 weeks.There was no statistical difference in VAS,percentage of loss of injured vertebrae anterior border and middle height of injured vertebrae and kyphosis Cobb angle between the 2 groups before the treatment(8.518+/-1.921 vs 8.786+/-1.580 points; t=0.505,P=0.616; 29.727+/-4.524% vs 30.261+/-4.192%; t=0.406,P=0.687; 24.750+/-3.872% vs 25.022+/-4.682%; t=0.210,P=0.835; 24.543+/-4.021 vs 25.121+/-3.954 degrees; t=0.481,P=0.633).One day after the surgery,the pain was relieved and the postoperative VAS scores were lower than the preoperative VAS scores in the two groups(t=25.561,P=0.000; t=35.927,P=0.000).The percentage of loss of injured vertebrae anterior border height,percentage of loss of injured vertebrae middle height and kyphosis Cobb angle decreased(t=42.400,P=0.000; t=38.572,P=0.000; t=47.929,P=0.000; t=27.563,P=0.000; t=38.627,P=0.000; t=31.531,P=0.000).However,there were no statistical differences between the 2 groups in all the therapeutic effect assessment indicators(2.886+/-1.205 vs 2.846+/-1.137 points; t=0.113,P=0.910; 11.546+/-2.903% vs 10.983+/-3.439%; t=0.587,P=0.561; 10.159+/-2.648% vs 9.637+/-2.371%; t=0.688,P=0.495; 9.872+/-2.361 vs 9.214+/-1.859 degrees; t=1.027,P=0.310).The bone cement leakage were found after the surgery in three patients in unilateral PKP group and in two patients in bilateral PKP group and no treatment were performed.No complications such as nerve injury,spinal cord injury and pulmonary embolism were found in the two groups.There was no statistical difference in the incidence rate of bone cement leakage between the 2 groups(χ2=0.000,P=1.000).Conclusion:Unilateral dilatation PKP with single balloon is similar to bilateral dilatation PKP with single balloon in the effect on pain relief,injured vertebral height restoration and spinal deformity correction,with few complications.However,unilateral dilatation PKP has the advantage of shorter operative time,fewer X-ray exposure and less bone cement consumption,therefore it is more suitable to weak and aged patients who can not withstand prolonged face lying.

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更新日期/Last Update: 2014-03-20