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[1]賈川,黎俊,趙洪,等.單側(cè)經(jīng)橫突-椎弓根入路與雙側(cè)經(jīng)椎弓根入路經(jīng)皮椎體成形術(shù)治療重度骨質(zhì)疏松性椎體壓縮性骨折合并脊柱側(cè)彎的比較研究[J].中醫(yī)正骨,2018,30(12):23-29.
　JIA Chuan,LI Jun,ZHAO Hong,et al.Percutaneous vertebroplasty through unilateral transverse process-pedicle approach versus bilateral transpedicular approach for treatment of severe osteoporotic vertebral compression fractures and scoliosis:a comparative study[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(12):23-29.
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單側(cè)經(jīng)橫突-椎弓根入路與雙側(cè)經(jīng)椎弓根入路經(jīng)皮椎體成形術(shù)治療重度骨質(zhì)疏松性椎體壓縮性骨折合并脊柱側(cè)彎的比較研究 ()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期數(shù):
2018年12期
頁碼:
23-29
欄目:
臨床研究
出版日期:
2018-12-20

文章信息/Info

Title:
Percutaneous vertebroplasty through unilateral transverse process-pedicle approach versus bilateral transpedicular approach for treatment of severe osteoporotic vertebral compression fractures and scoliosis:a comparative study
作者:
賈川1; 黎俊2; 趙洪2; 彭立波2; 謝子康2; 瞿玉興2
(1.南京中醫(yī)藥大學(xué),江蘇 南京 210046; 2.江蘇省常州市中醫(yī)醫(yī)院,江蘇 常州 213003)
Author(s):
JIA Chuan1; LI Jun2; ZHAO Hong2; PENG Libo2; XIE Zikang2; QU Yuxing2
1.Nanjing University of Traditional Chinese Medicine,Nanjing 210046,Jiangsu,China 2.Changzhou Hospital of Traditional Chinese Medicine,Changzhou 213003,Jiangsu,China
關(guān)鍵詞:
骨折; 壓縮性;  骨質(zhì)疏松性骨折;  胸椎;  腰椎;  脊柱側(cè)凸;  椎體成形術(shù);  手術(shù)入路;  臨床試驗(yàn)
Keywords:
fractures; compression;  osteoporotic fractures;  thoracic vertebrae;  lumbar vertebroplasy;  scoliosis;  ertebroplasty;  surgical approach;  clinical trial
摘要:
目的:比較單側(cè)經(jīng)橫突-椎弓根入路經(jīng)皮椎體成形術(shù)(percutaneous vertebroplasty,PVP)與雙側(cè)經(jīng)椎弓根入路PVP治療重度骨質(zhì)疏松性椎體壓縮性骨折(osteoporotic vertebral compression fractures,OVCF)合并脊柱側(cè)彎的臨床療效和安全性。方法:將符合要求的36例重度OVCF合并脊柱側(cè)彎患者隨機(jī)分為2組,每組18例,分別采用單側(cè)經(jīng)橫突-椎弓根入路PVP治療(單側(cè)組)和雙側(cè)經(jīng)椎弓根入路PVP治療(雙側(cè)組)。記錄并比較2組患者的手術(shù)時間、X線透視次數(shù)、骨水泥灌注量、住院時間、并發(fā)癥發(fā)生情況以及術(shù)后第2天椎體高度恢復(fù)率[(術(shù)后椎體高度-術(shù)前椎體高度)/術(shù)后椎體高度]和脊柱側(cè)彎Cobb角糾正度數(shù)(術(shù)前Cobb角-術(shù)后Cobb角),并分別于術(shù)前及術(shù)后1周、3個月、12個月比較2組患者腰背部疼痛視覺模擬量表(visual analogue scale,VAS)評分及Oswestry功能障礙指數(shù)(Oswestry disability index,ODI)。結(jié)果:①一般情況。2組患者均獲隨訪,隨訪時間(18.3±6.4)個月。2組患者術(shù)后第2天椎體高度恢復(fù)率和脊柱側(cè)彎Cobb角糾正度數(shù)以及骨水泥灌注量、住院時間比較,差異均無統(tǒng)計(jì)學(xué)意義[(27.6±5.6)%,(28.3±4.9)%,t=0.400,P=0.700; 8.2°±2.8°,8.9°±3.1°,t=0.710,P=0.480;(4.0±0.7)mL,(4.2±0.8)mL,t=0.800,P=0.430;(9.5±2.1)d,(9.6±2.2)d,t=0.140,P=0.890]; 單側(cè)組手術(shù)時間短于雙側(cè)組[(23.4±4.3)min,(32.6±5.6)min,t=5.530,P=0.000],X線透視次數(shù)少于雙側(cè)組[(5.8±0.8)次,(9.7±1.1)次,t=12.170,P=0.000]。②腰背部疼痛VAS評分。時間因素與分組因素不存在交互效應(yīng)(F=2.520,P=0.270); 2組患者腰背部疼痛VAS評分比較,組間差異無統(tǒng)計(jì)學(xué)意義,即不存在分組效應(yīng)(F=1.420,P=0.150); 手術(shù)前后不同時間點(diǎn)之間腰背部疼痛VAS評分的差異有統(tǒng)計(jì)學(xué)意義,即存在時間效應(yīng)(F=34.620,P=0.000); 2組患者腰背部疼痛VAS評分隨時間均呈降低趨勢,且2組的降低趨勢完全一致[(6.7±0.9)分,(2.8±1.2)分,(2.2±0.7)分,(1.6±0.7)分,F=8.870,P=0.000;(6.6±0.8)分,(2.8±1.1)分,(2.0±0.6)分,(1.4±0.7)分,F=6.320,P=0.000]。③ODI。時間因素與分組因素不存在交互效應(yīng)(F=20.360,P=0.380); 2組患者ODI比較,組間差異無統(tǒng)計(jì)學(xué)意義,即不存在分組效應(yīng)(F=3.440,P=0.640); 手術(shù)前后不同時間點(diǎn)之間ODI的差異有統(tǒng)計(jì)學(xué)意義,即存在時間效應(yīng)(F=25.480,P=0.000); 2組患者ODI隨時間均呈降低趨勢,且2組的降低趨勢完全一致[(68.1±6.1)%,(32.6±5.9)%,(22.2±3.8)%,(18.2±2.6)%,F=22.740,P=0.000;(70.5±5.3)%,(32.4±4.6)%,(20.7±4.1)%,(17.3±3.4)%,F=50.910,P=0.000]。④安全性。雙側(cè)組2例出現(xiàn)鄰近椎體再骨折,單側(cè)組1例出現(xiàn)鄰近椎體再骨折,均給予臥床休息及抗骨質(zhì)疏松等治療后骨折愈合; 雙側(cè)組1例穿刺部位出現(xiàn)血腫,給予活血藥治療1周后血腫消退; 2組均未出現(xiàn)骨水泥滲漏致脊髓損傷、硬膜囊撕裂及氣胸等并發(fā)癥; 2組并發(fā)癥發(fā)生率比較,差異無統(tǒng)計(jì)學(xué)意義(P=0.603)。結(jié)論:單側(cè)經(jīng)橫突-椎弓根入路PVP與雙側(cè)經(jīng)椎弓根入路PVP治療重度OVCF合并脊柱側(cè)彎畸形,均能恢復(fù)椎體高度,矯正側(cè)彎畸形,緩解腰背部疼痛,促進(jìn)腰椎功能的恢復(fù),住院時間短,并發(fā)癥少,且骨水泥灌注量相當(dāng),但前者比后者的手術(shù)時間短、X線輻射少。
Abstract:
Objective:To compare the clinical curative effects and safety of percutaneous vertebroplasty(PVP)through unilateral transverse process-pedicle approach versus PVP through bilateral transpedicular approach for treatment of severe osteoporotic vertebral compression fractures(OVCF)and scoliosis.Methods:Thirty-six patients with severe OVCF and scoliosis enrolled in the study were randomly divided into 2 groups,18 cases in each group.The patients were treated with PVP through unilateral transverse process-pedicle approach(unilateral group)and PVP through bilateral transpedicular approach(bilateral group)respectively.The operative time,frequency of X-ray exposure,consumption of bone cements,hospital stays,complications and vertebral height recovery rate(ratio of postoperative increased vertebral height to postoperative vertebral height)and Cobb angle correction degree(increased degree of Cobb angle)of scoliosis measured at postoperative day 2 were compared between the 2 groups respectively.The low back pain visual analogue scale(VAS)scores and Oswestry disability index(ODI)were compared between the 2 groups before the operation and at 1 week,3 and 12 months after the operation respectively.Results:All patients in the 2 groups were followed up for 18.3+/-6.4 months.There was no statistical difference in vertebral height recovery rate and Cobb angle correction degree of scoliosis measured at postoperative day 2,consumption of bone cements and hospital stays between the 2 groups(27.6+/-5.6 vs 28.3+/-4.9%,t=0.400,P=0.700; 8.2+/-2.8 vs 8.9+/-3.1 degrees,t=0.710,P=0.480; 4.0+/-0.7 vs 4.2+/-0.8 mL,t=0.800,P=0.430; 9.5+/-2.1 vs 9.6+/-2.2 days,t=0.140,P=0.890).The operative time was shorter and the X-ray exposure was fewer in unilateral group compared to bilateral group(23.4+/-4.3 vs 32.6+/-5.6 minutes,t=5.530,P=0.000; 5.8+/-0.8 vs 9.7+/-1.1 times,t=12.170,P=0.000).There was no interaction between time factor and group factor in low back pain VAS scores(F=2.520,P=0.270).There was no statistical difference in low back pain VAS scores between the 2 groups,in other words,there was no group effect(F=1.420,P=0.150).There was statistical difference in low back pain VAS scores between different timepoints before and after the operation,in other words,there was time effect(F=34.620,P=0.000).The low back pain VAS scores presented a time-dependent decreasing trend in both of the 2 groups,and the 2 groups were consistent with each other in the decreasing trend of low back pain VAS scores(6.7+/-0.9,2.8+/-1.2,2.2+/-0.7,1.6+/-0.7 points,F=8.870,P=0.000; 6.6+/-0.8,2.8+/-1.1,2.0+/-0.6,1.4+/-0.7 points,F=6.320,P=0.000).There was no interaction between time factor and group factor in ODI(F=20.360,P=0.380).There was no statistical difference in ODI between the 2 groups,in other words,there was no group effect(F=3.440,P=0.640).There was statistical difference in ODI between different timepoints before and after the operation,in other words,there was time effect(F=25.480,P=0.000).The ODI presented a time-dependent decreasing trend in both of the 2 groups,and the 2 groups were consistent with each other in the decreasing trend of ODI(68.1+/-6.1,32.6+/-5.9,22.2+/-3.8,18.2+/-2.6%,F=22.740,P=0.000; 70.5+/-5.3,32.4+/-4.6,20.7+/-4.1,17.3+/-3.4%,F=50.910,P=0.000).Adjacent vertebrae fractures were found in 2 patients in bilateral group and 1 patient in unilateral group,and the fractures healed after rest in bed and anti-osteoporosis treatment.The hematoma was found at the puncture site after the operation in 1 patient in bilateral group,and it subsided after 1-week treatment with blood-activating drugs.No complications such as spinal cord injuries which was caused by bone cement leakage and dural sac avulsion and aerothorax were found in the 2 groups.There was no statistical difference in complication incidences between the 2 groups(P=0.603).Conclusion:Both PVP through unilateral transverse process-pedicle approach and PVP through bilateral transpedicular approach can restore vertebral height,correct scoliosis deformity,relieve low back pain and promote lumbar function recovery in treatment of severe OVCF and scoliosis with short hospital stays and few complications,and they are similar to each other in consumption of bone cements,while the former has the advantages of shorter operative time and less X-ray radiation compared to the latter.

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通訊作者:瞿玉興 E-mail:[email protected](收稿日期:2018-05-17 本文編輯:時紅磊)
更新日期/Last Update: 2019-05-30