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[1]王寶虎,鄔博來,馬智敏,等.單側(cè)與雙側(cè)椎弓根入路經(jīng)皮椎體后凸成形術(shù)治療骨質(zhì)疏松性椎體側(cè)方壓縮性骨折的對比研究[J].中醫(yī)正骨,2021,33(08):16-22.
　WANG Baohu,WU Bolai,MA Zhimin,et al.A comparative study of percutaneous kyphoplasty through unipedicular approach versus bipedicular approach for treatment of lateral osteoporotic vertebral compression fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(08):16-22.
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單側(cè)與雙側(cè)椎弓根入路經(jīng)皮椎體后凸成形術(shù)治療骨質(zhì)疏松性椎體側(cè)方壓縮性骨折的對比研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期數(shù):
2021年08期
頁碼:
16-22
欄目:
臨床研究
出版日期:
2021-08-20

文章信息/Info

Title:
A comparative study of percutaneous kyphoplasty through unipedicular approach versus bipedicular approach for treatment of lateral osteoporotic vertebral compression fractures
作者:
王寶虎; 鄔博來; 馬智敏; 吳樂彬
(湖州市中醫(yī)院,浙江 湖州 313000)
Author(s):
WANG Baohu; WU Bolai; MA Zhimin; WU Lebin
Huzhou Hospital of Traditional Chinese Medicine,Huzhou 313000,Zhejiang,China
關(guān)鍵詞:
骨質(zhì)疏松性骨折;  骨折; 壓縮性;  胸椎;  腰椎;  椎體后凸成形術(shù);  手術(shù)入路;  臨床試驗(yàn)
Keywords:
osteoporotic fractures;  fractures; compression;  thoracic vertebrae;  lumbar vertebrae;  kyphoplasty;  operative approach;  clinical trial
摘要:
目的:比較單側(cè)與雙側(cè)椎弓根入路經(jīng)皮椎體后凸成形術(shù)(percutaneous kyphoplasty,PKP)治療骨質(zhì)疏松性椎體側(cè)方壓縮性骨折的臨床療效。方法:回顧性分析54例骨質(zhì)疏松性椎體側(cè)方壓縮性骨折患者的病例資料,其中采用單側(cè)椎弓根入路PKP治療23例(單側(cè)入路組),采用雙側(cè)椎弓根入路PKP治療31例(雙側(cè)入路組)。男16例,女38例。年齡55～91歲,中位數(shù)71.5歲。比較2組患者術(shù)后1周骨水泥彌散系數(shù),術(shù)前及術(shù)后1個(gè)月、6個(gè)月、12個(gè)月、24個(gè)月椎體壓縮側(cè)凸角、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)評分。結(jié)果:①骨水泥彌散系數(shù)。術(shù)后1周,單側(cè)入路組骨水泥彌散系數(shù)低于雙側(cè)入路組(17.12±5.14)%,(28.07±3.29)%,t=51.740,P=0.001]。②椎體壓縮側(cè)凸角。時(shí)間因素和分組因素不存在交互效應(yīng)(F=4.107,P=0.074); 2組患者椎體壓縮側(cè)凸角總體比較,組間差異無統(tǒng)計(jì)學(xué)意義,即不存在分組效應(yīng)(F=8.371,P=0.241); 手術(shù)前后不同時(shí)間點(diǎn)椎體壓縮側(cè)凸角的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=428.107,P=0.000); 2組患者椎體壓縮側(cè)凸角隨時(shí)間變化均呈下降趨勢,且2組的下降趨勢完全一致(單側(cè)入路組:23.17°±3.51°,10.84°±2.53°,10.77°±2.61°,10.75°±2.70°,10.71°±2.73°,F=532.236,P=0.000; 雙側(cè)入路組:25.08°±2.78°,9.70°±1.81°,9.67°±2.17°,9.69°±2.28°,9.69°±2.32°,F=219.463,P=0.000)。③腰背部疼痛VAS評分。時(shí)間因素和分組因素存在交互效應(yīng)(F=3.805,P=0.005); 2組患者腰背部疼痛VAS評分總體比較,組間差異有統(tǒng)計(jì)學(xué)意義,即存在分組效應(yīng)(F=18.963,P=0.014); 手術(shù)前后不同時(shí)間點(diǎn)腰背部疼痛VAS評分的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=394.152,P=0.000); 2組患者腰背部疼痛VAS評分隨時(shí)間變化均呈下降趨勢,但2組的下降趨勢不完全一致[單側(cè)入路組:(8.1±2.1)分,(3.2±0.5)分,(2.7±0.5)分,(2.9±0.5)分,(3.1±0.4)分,F=414.275,P=0.000; 雙側(cè)入路組:(8.3±1.6)分,(2.9±0.4)分,(2.4±0.4)分,(2.2±0.4)分,(2.0±0.4)分,F=374.551,P=0.000]; 術(shù)前及術(shù)后1個(gè)月,2組患者腰背部疼痛VAS評分的組間差異均無統(tǒng)計(jì)學(xué)意義(t=0.317,P=0.714; t=5.271,P=0.410); 術(shù)后6個(gè)月、12個(gè)月、24個(gè)月,單側(cè)入路組腰背部疼痛VAS評分均高于雙側(cè)入路組(t=6.711,P=0.033; t=10.724,P=0.018; t=11.254,P=0.022)。④ODI評分。時(shí)間因素和分組因素存在交互效應(yīng)(F=2.127,P=0.007); 2組患者ODI評分總體比較,組間差異有統(tǒng)計(jì)學(xué)意義,即存在分組效應(yīng)(F=316.788,P=0.038); 手術(shù)前后不同時(shí)間點(diǎn)ODI評分的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=517.438,P=0.000); 2組患者ODI評分隨時(shí)間變化均呈下降趨勢,但2組的下降趨勢不完全一致[單側(cè)入路組:(39.04±3.79)分,(17.28±2.73)分,(14.78±1.17)分,(17.41±1.18)分,(16.94±2.23)分,F=379.616,P=0.000; 雙側(cè)入路組:(35.08±2.78)分,(16.47±2.69)分,(15.34±2.56)分,(13.55±2.07)分,(12.74±1.57)分,F=307.398,P=0.000]; 術(shù)前及術(shù)后1個(gè)月、6個(gè)月,2組患者ODI評分的組間差異均無統(tǒng)計(jì)學(xué)意義(t=1.273,P=0.548; t=13.127,P=0.109; t=18.074,P=0.074); 術(shù)后12個(gè)月、24個(gè)月,單側(cè)入路組ODI評分均高于雙側(cè)入路組(t=18.981,P=0.021; t=21.279,P=0.014)。結(jié)論:相較于單側(cè)椎弓根入路PKP,雙側(cè)椎弓根入路PKP治療骨質(zhì)疏松性椎體側(cè)方壓縮性骨折,能更好地促使骨水泥彌散、緩解腰背部疼痛、改善胸腰椎功能,但二者在糾正椎體側(cè)凸畸形方面療效相當(dāng)。
Abstract:
Objective:To compare the clinical curative effects of percutaneous kyphoplasty(PKP)through unipedicular approach versus bipedicular approach for treatment of lateral osteoporotic vertebral compression fractures(OVCFs).Methods:The medical records of 54 patients with lateral OVCFs were analyzed retrospectively.Twenty-three patients were treated with PKP through unipedicular approach(unipedicular approach group),while the others were treated with PKP through bipedicular approach(bipedicular approach group).The patients consisted of 16 males and 38 females,and ranged in age from 55 to 91 years(Median=71.5 yrs).The bone cement diffusion coefficient measured at 1 week after the surgery and the vertebral compression scoliosis angle,low back pain visual analogue scale(VAS)scores and Oswestry disability index(ODI)scores evaluated before the surgery and at 1 month,6,12 and 24 months after the surgery were compared between the 2 groups respectively.Results:The bone cement diffusion coefficient was lower in unipedicular approach group compared to bipedicular approach group at 1 week after the surgery(17.12±5.14 vs 28.07±3.29%,t=51.740,P=0.001).There was no interaction between time factor and group factor in vertebral compression scoliosis angle(F=4.107,P=0.074).There was no statistical difference in vertebral compression scoliosis angle between the 2 groups in general,in other words,there was no group effect(F=8.371,P=0.241).There was statistical difference in vertebral compression scoliosis angle between different timepoints before and after the surgery,in other words,there was time effect(F=428.107,P=0.000).The vertebral compression scoliosis angle presented a time-dependent decreasing trend in the 2 groups,and the 2 groups were exactly consistent with each other in the variation tendency(unipedicular approach group:23.17±3.51,10.84±2.53,10.77±2.61,10.75±2.70,10.71±2.73 degrees,F=532.236,P=0.000; bipedicular approach group:25.08±2.78,9.70±1.81,9.67±2.17,9.69±2.28,9.69±2.32 degrees,F=219.463,P=0.000).There was interaction between time factor and group factor in low back pain VAS scores(F=3.805,P=0.005).There was statistical difference in low back pain VAS scores between the 2 groups in general,in other words,there was group effect(F=18.963,P=0.014).There was statistical difference in low back pain VAS scores between different timepoints before and after the surgery,in other words,there was time effect(F=394.152,P=0.000).The low back pain VAS scores presented a time-dependent decreasing trend in the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(unipedicular approach group:8.1±2.1,3.2±0.5,2.7±0.5,2.9±0.5,3.1±0.4 points,F=414.275,P=0.000; bipedicular approach group:8.3±1.6,2.9±0.4,2.4±0.4,2.2±0.4,2.0±0.4 points,F=374.551,P=0.000).The comparison of low back pain VAS scores between the 2 groups revealed no significant differences before the surgery and at 1 month after the surgery(t=0.317,P=0.714; t=5.271,P=0.410); while,at 6,12 and 24 months after the surgery,the low back pain VAS scores were higher in unipedicular approach group compared to bipedicular approach group(t=6.711,P=0.033; t=10.724,P=0.018; t=11.254,P=0.022)...

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通訊作者:鄔博來 E-mail:[email protected]
更新日期/Last Update: 1900-01-01