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[1]陳建德,樊曉琦,凌義龍.單側(cè)椎弓根旁外側(cè)入路與雙側(cè)椎弓根入路 經(jīng)皮椎體后凸成形術(shù)治療骨質(zhì)疏松性胸椎 壓縮性骨折的對(duì)比研究[J].中醫(yī)正骨,2018,30(10):19-29.
　CHEN Jiande,FAN Xiaoqi,LING Yilong.A retrospective trial of percutaneous kyphoplasty through unilateral extrapedicular approach versus bilateral transpedicular approach for treatment of thoracic osteoporotic vertebral compression fracture[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(10):19-29.
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單側(cè)椎弓根旁外側(cè)入路與雙側(cè)椎弓根入路 經(jīng)皮椎體后凸成形術(shù)治療骨質(zhì)疏松性胸椎 壓縮性骨折的對(duì)比研究()
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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10期
頁(yè)碼:
19-29
欄目:
臨床研究
出版日期:
2018-10-20

文章信息/Info

Title:
A retrospective trial of percutaneous kyphoplasty through unilateral extrapedicular approach versus bilateral transpedicular approach for treatment of thoracic osteoporotic vertebral compression fracture
作者:
陳建德; 樊曉琦; 凌義龍
(浙江省紹興市中醫(yī)院,浙江 紹興 312000)
Author(s):
CHEN Jiande; FAN Xiaoqi; LING Yilong
Shaoxing Hospital of Traditional Chinese Medicine,Shaoxing 312000,Zhejiang,China
關(guān)鍵詞:
骨質(zhì)疏松性骨折;  脊柱骨折;  胸椎;  椎體后凸成形術(shù)
Keywords:
osteoporotic fractures;  spinal fractures;  thoracic vertebrae;  kyphoplasty
摘要:
目的:比較單側(cè)椎弓根旁外側(cè)入路與雙側(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)疏松性胸椎壓縮性骨折的臨床療效和安全性。方法:回顧性分析47例骨質(zhì)疏松性胸椎壓縮性骨折患者的病例資料,其中采用單側(cè)椎弓根旁外側(cè)入路PKP治療22例(單側(cè)組),采用雙側(cè)椎弓根入路PKP治療25例(雙側(cè)組)。男12例,女35例; 年齡61～83歲,中位數(shù)68歲; 骨折椎體位于T61例、T71例、T84例、T92例、T1010例、T1115例、T1214例。比較2組患者的手術(shù)時(shí)間、骨水泥灌注量、胸腰背部疼痛視覺(jué)模擬量表(visual analogue scale,VAS)評(píng)分、椎體前緣高度及并發(fā)癥發(fā)生情況。結(jié)果:①手術(shù)時(shí)間和骨水泥灌注量。單側(cè)組手術(shù)時(shí)間短于雙側(cè)組[(37.18±7.06)min,(42.20±8.42)min,t=2.196,P=0.033],骨水泥灌注量少于雙側(cè)組[(3.89±0.67)mL,(4.78±0.84)mL,t=3.983,P=0.000]。②胸腰背部疼痛VAS評(píng)分。時(shí)間因素與分組因素不存在交互效應(yīng)(F=0.219,P=0.804); 2組患者胸腰背部疼痛VAS評(píng)分比較,組間差異無(wú)統(tǒng)計(jì)學(xué)意義,即不存在分組效應(yīng)(F=0.157,P=0.694); 手術(shù)前后不同時(shí)間點(diǎn)之間胸腰背部疼痛VAS評(píng)分的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=524.723,P=0.000); 2組患者胸腰背部疼痛VAS評(píng)分隨時(shí)間均呈降低趨勢(shì),且2組的降低趨勢(shì)完全一致[(6.45±0.91)分,(2.18±0.91)分,(1.86±0.71)分, F=192.881,P=0.000;(6.44±0.82)分,(2.36±0.86)分,(1.88±0.60)分, F=375.230,P=0.000]。③椎體前緣高度。時(shí)間因素與分組因素不存在交互效應(yīng)(F=6.416,P=0.130); 2組患者椎體前緣高度比較,組間差異無(wú)統(tǒng)計(jì)學(xué)意義,即不存在分組效應(yīng)(F=0.332,P=0.567); 手術(shù)前后不同時(shí)間點(diǎn)之間椎體前緣高度的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=7.265,P=0.008); 2組患者椎體前緣高度隨時(shí)間均呈升高趨勢(shì),且2組的升高趨勢(shì)完全一致[(18.14±2.82)分,(19.89±2.74)分,(19.73±2.75)分, F=338.832,P=0.000;(18.12±2.09)分,(20.51±1.99)分,(20.31±1.99)分, F=114.890,P=0.000]。④安全性。2組均未出現(xiàn)肺栓塞、低氧血癥等骨水泥植入綜合征以及切口感染、血腫形成。單側(cè)組4例出現(xiàn)骨水泥滲漏,其中側(cè)前方滲漏1例、椎間盤(pán)滲漏2例、靜脈叢滲漏1例; 1例出現(xiàn)傷椎鄰近椎體骨折。雙側(cè)組10例出現(xiàn)骨水泥滲漏,其中側(cè)前方滲漏8例、椎間盤(pán)滲漏2例; 1例出現(xiàn)肋間神經(jīng)損傷,2例出現(xiàn)傷椎鄰近椎體骨折。單側(cè)組并發(fā)癥發(fā)生率低于雙側(cè)組(χ2=4.243,P=0.039)。因骨水泥滲漏量少,未出現(xiàn)神經(jīng)根癥狀,均未做特殊處理; 鄰近椎體骨折者,再次行PKP治療后治愈。結(jié)論:單側(cè)椎弓根旁外側(cè)入路與雙側(cè)椎弓根入路PKP治療骨質(zhì)疏松性胸椎壓縮性骨折,均能緩解胸腰背部疼痛和恢復(fù)椎體高度,但前者較后者手術(shù)時(shí)間短、骨水泥灌注量少、并發(fā)癥少。
Abstract:
Objective:To compare the clinical curative effect and safety of percutaneous kyphoplasty(PKP)through unilateral extrapedicular approach versus bilateral transpedicular approach for treatment of thoracic osteoporotic vertebral compression fracture(OVCF).Methods:The medical records of 47 patients with thoracic OVCFs were analyzed retrospectively.Twenty-two patients were treated with PKP through unilateral extrapedicular approach(unilateral group),while the others were treated with PKP through bilateral transpedicular approach(bilateral group).The patients consisted of 12 males and 35 females,and ranged in age from 61 to 83 years(Median=68 yrs).The fractures located at T6(1),T7(1),T8(4),T9(2),T10(10),T11(15)and T12(14).Operative time,consumption of bone cements,thoracolumbar pain visual analogue scale(VAS)scores,vertebrae anterior border height and postoperative complications were compared between the 2 groups respectively.Results:The operative time was shorter and the consumption of bone cements was less in unilateral group compared to bilateral group(37.18+/-7.06 vs 42.20+/-8.42 min,t=2.196,P=0.033; 3.89+/-0.67 vs 4.78+/-0.84 mL,t=3.983,P=0.000).There was no interaction between time factor and group factor in thoracolumbar pain VAS scores(F=0.219,P=0.804).There was no statistical difference in the thoracolumbar pain VAS scores between the 2 groups,in other words,there was no group effect(F=0.157,P=0.694).There was statistical difference in the thoracolumbar pain VAS scores between different timepoints before and after the surgery,in other words,there was time effect(F=524.723,P=0.000).The thoracolumbar 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 thoracolumbar pain VAS scores(6.45+/-0.91,2.18+/-0.91,1.86+/-0.71 points,F=192.881,P=0.000; 6.44+/-0.82,2.36+/-0.86,1.88+/-0.60 points,F=375.230,P=0.000).There was no interaction between time factor and group factor in vertebrae anterior border height(F=6.416,P=0.130).There was no statistical difference in vertebrae anterior border height between the 2 groups,in other words,there was no group effect(F=0.332,P=0.567).There was statistical difference in vertebrae anterior border height between different timepoints before and after the surgery,in other words,there was time effect(F=7.265,P=0.008).The vertebrae anterior border height presented a time-dependent increasing trend in both of the 2 groups,and the 2 groups were consistent with each other in the increasing trend of vertebrae anterior border height(18.14+/-2.82,19.89+/-2.74,19.73+/-2.75 points,F=338.832,P=0.000; 18.12+/-2.09,20.51+/-1.99,20.31+/-1.99 points,F=114.890,P=0.000). Bone cement implantation syndromes such as pulmonary embolism and hypoxemia,incision infection and hematoma were not found in the 2 groups.The bone cement leakage were found in 14 patients.Anterolateral leakage(1),leakage into intervertebral disc(2)and venous plexus(1)were found in unilateral group,while anterolateral leakage(8)and leakage into intervertebral disc(2)were found in bilateral group.The adjacent vertebral fracture(1)was found in unilateral group.The intercostals nerve injury(1)and the adjacent vertebral fractures(2)were found in bilateral group.The incidence rate of postoperative complication was lower in unilateral group compared to bilateral group(χ2=4.243,P=0.039).No nerve root symptoms appeared due to small amount of bone cement leakage,so the patients were not given any special treatment.The patients with adjacent vertebral fractures were cured with another PKP.Conclusion:Both PKP through unilateral extrapedicular approach and PKP through bilateral transpedicular approach can alleviate thoracolumbar pain and restore vertebral height in the treatment of thoracic OVCF,however,the former has such advantages as shorter operative time,less consumption of bone cements and postoperative complications.

參考文獻(xiàn)/References:


[1] BOONEN S,WAHL DA,NAUROY L,et al.Balloon kyphoplasty and vertebroplasty in the management of vertebral compression fractures[J].Osteoporos Int,2011,22(12):2915-2934.
[2] 楊惠林,YUAN HA,陳亮,等.椎體后凸成形術(shù)治療老年骨質(zhì)疏松脊柱壓縮骨折[J].中華骨科雜志,2004,23(5):262-265.
[3] 黃勝,許靖,項(xiàng)禹誠(chéng),等.單側(cè)與雙側(cè)入路經(jīng)皮椎體成形術(shù)治療骨質(zhì)疏松壓縮性骨折的比較研究[J].中國(guó)矯形外科雜志,2013,21(2):115-118.
[4] 楊建平,謝國(guó)華,薛峰,等.單球囊單、雙側(cè)擴(kuò)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比較[J].中醫(yī)正骨,2014,26(3):21-24.
[5] 申勇,劉法敬,張英澤,等.單、雙側(cè)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療效[J].中國(guó)脊柱脊髓雜志,2011,21(3):202-206.
[6] 蔣協(xié)遠(yuǎn),王大偉.骨科臨床療效評(píng)價(jià)標(biāo)準(zhǔn)[M].北京:人民衛(wèi)生出版社,2005:123.
[7] 中國(guó)老年學(xué)學(xué)會(huì)骨質(zhì)疏松委員會(huì),骨質(zhì)疏松癥診斷標(biāo)準(zhǔn)學(xué)科組.中國(guó)人骨質(zhì)疏松癥診斷標(biāo)準(zhǔn)專家共識(shí)(第三稿·2014版)[J].中國(guó)骨質(zhì)疏松雜志,2014,20(9):1007-1010.
[8] 王璐,趙琳,劉伯鋒,等.胸椎椎弓根應(yīng)用解剖對(duì)椎弓根釘置入方法的影響[J].中國(guó)老年學(xué)雜志,2013,33(18):4387-4390.
[9] BOUZA C,LPEZ-CUADRADO T,ALMENDRO N,et al.Safety of balloon kyphoplasty in the treatment of osteoporotic vertebral compression fractures in Europe:a meta-analysis of randomized controlled trials[J].Eur Spine J,2015,24(4):715-723.
[10] 譚中寶,狄鎮(zhèn)海,張建,等.CT圖像模擬穿刺路徑在經(jīng)皮椎體成形術(shù)中的應(yīng)用價(jià)值[J].放射學(xué)實(shí)踐,2012,27(9):998-1000.
[11] CHEN LH,HSIEH MK,LIAO JC,et al.Repeated percutaneous vertebroplasty for refracture of cemented vertebrae[J].Arch Orthop Trauma Surg,2011,131(7):927-933.
[12] 王想福,范有福,石瑞芳,等.單側(cè)穿刺椎體后凸成形術(shù)骨水泥分布與穿刺角度的關(guān)系[J].中國(guó)骨傷,2015,28(8):704-707.
[13] ZHONG BY,WU CG,HE SC,et al.ANVCFV score system:assessment for probability of new vertebral compression fractures after percutaneous vertebroplasty in patients with vertebral compression fractures[J].Pain Physician,2015,18(6):1047-1057.
[14] PHILLIPS FM,TODD WETZEL F,LIEBERMAN I,et al.An in vivo comparison of the potential for extravertebral cement leak after vertebroplasty and kyphoplasty[J].Spine(Phila Pa 1976),2002,27(19):2173-2178.
[15] 魯常勝,蔣濤,魯婷瑋,等.經(jīng)皮椎體后凸成形術(shù)椎管內(nèi)骨水泥滲漏的診斷及預(yù)防[J].臨床骨科雜志,2017,20(1):30-33.
[16] 耿家金,趙平,牛和明,等.分次灌注骨水泥技術(shù)治療骨質(zhì)疏松性椎體壓縮骨折療效觀察[J].中國(guó)骨與關(guān)節(jié)損傷雜志,2013,28(3):225-227.
[17] 王遠(yuǎn)政,田曉濱,李波,等.高粘度骨水泥與低粘度骨水泥經(jīng)皮椎體成形術(shù)治療嚴(yán)重骨質(zhì)疏松性椎體壓縮性骨折的前瞻性比較研究[J].中華創(chuàng)傷骨科雜志,2017,19(1):54-60.
[18] 鄭毓嵩,張勇,林金丁,等.椎體成形術(shù)骨水泥滲漏的相關(guān)危險(xiǎn)因素分析[J].中華創(chuàng)傷雜志,2015,31(4):312-316.
[19] TAYLOR RS,TAYLOR RJ,FRITZELL P.Balloon kyphoplasty and vertebroplasty for vertebral compression fractures—A comparative systematic review of efficacy and safety[J].Spine(Phila Pa 1976),2006,31(23):2747-2755.
[20] 陳建德,樊曉琦,夏炳江,凌義龍.球囊擴(kuò)張部位對(duì)椎體后凸成形術(shù)治療骨質(zhì)疏松性椎體壓縮骨折療效及安全性的影響[J].中醫(yī)正骨,2017,29(2):11-16.(收稿日期:2018-03-15 本文編輯:時(shí)紅磊)

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　YU Xing,WANG Ting,YANG Jizhou,et al.A retrospective trial of percutaneous vertebroplasty versus percutaneous kyphoplasty for treatment of Kmmell's diseases[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(10):23.
[14]彭小東,張曉剛,趙文韜,等.有限元分析在過(guò)伸復(fù)位治療骨質(zhì)疏松性椎體壓縮性骨折生物力學(xué)研究中的應(yīng)用進(jìn)展[J].中醫(yī)正骨,2018,30(07):25.
[15]于東方,王祥善,張華,等.經(jīng)皮椎體成形術(shù)后手術(shù)椎體再骨折的病因、治療及預(yù)防[J].中醫(yī)正骨,2018,30(10):69.
[16]李兆勇,楊少鋒,張晨陽(yáng).補(bǔ)腎活血方聯(lián)合經(jīng)皮椎體強(qiáng)化術(shù)治療骨質(zhì)疏松性椎體壓縮骨折的系統(tǒng)評(píng)價(jià)[J].中醫(yī)正骨,2019,31(03):28.
　LI Zhaoyong,YANG Shaofeng,ZHANG Chenyang.Oral application of Bushen Huoxue Fang(補(bǔ)腎活血方)combined with percutaneous vertebral augmentation for treatment of osteoporotic vertebral compression fractures:a systematic review[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(10):28.
[17]楊磊,崔宏勛,饒耀劍,等.彎角穿刺椎體成形裝置輔助下單側(cè)穿刺經(jīng)皮椎體成形術(shù)治療骨質(zhì)疏松性椎體壓縮骨折[J].中醫(yī)正骨,2020,32(01):64.
[18]陳晨,安忠誠(chéng),張英健,等.椎體強(qiáng)化術(shù)后殘留腰背痛的研究進(jìn)展[J].中醫(yī)正骨,2020,32(05):26.
[19]劉銳,龔德飛,班正濤,等.經(jīng)皮椎體成形術(shù)治療骨質(zhì)疏松性椎體壓縮骨折術(shù)中骨水泥滲漏的危險(xiǎn)因素分析[J].中醫(yī)正骨,2022,34(11):14.
　LIU Rui,GONG Defei,BAN Zhengtao,et al.Risk factors for bone cement leakage during percutaneous vertebroplasty treatment of osteoporotic vertebral compression fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(10):14.
[20]羅金金,丁彩田.骨質(zhì)疏松性椎體壓縮骨折經(jīng)皮椎體后凸成形術(shù)后脊柱后凸畸形改善程度的影響因素分析[J].中醫(yī)正骨,2022,34(08):8.
　LUO Jinjin,DING Caitian.Analysis of factors influencing the degree of improvement of spinal kyphosis deformity after percutaneous kyphoplasty for treatment of osteoporotic vertebral compression fracture[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(10):8.

更新日期/Last Update: 2019-02-25