摘要
目的探讨经皮椎体后凸成形术（PKP）治疗骨质疏松性椎体压缩骨折中骨水泥单侧与双侧弥散对疗效的影响。方法采用回顾性病例对照研究分析2013年7月-2015年7月单侧穿刺行PKP治疗的127例单节段骨质疏松性椎体压缩骨折患者临床资料。按照骨水泥弥散是否超过中线分为单侧弥散组和双侧弥散组。单侧弥散组72例，其中男29例，女43例；年龄63～76岁[（69．5±2．6）岁]；伤椎分布：L，38例，L220例，L311例，L42例，L51例；术前视觉模拟评分（VAS）为（7．8±0．9）分，伤椎前缘压缩率为（32．5±6．3）％，伤椎矢状面Cobb角为（9．2±1．3）°。双侧弥散组55例，其中男22例，女33例；年龄61—80岁[（71．2±2．9）岁]；伤椎分布：L，32例，L：13例，L，6例，L43例，L，1例；术前VAS为（7．6±0．9）分，伤椎前缘压缩率为（34．5±5．8）％，伤椎矢状面Cobb角为（9．8±1．5）°。记录两组术后1个月和1年VAS、术后伤椎前缘高度压缩率、术后伤椎矢状面Cobb角，以及术后伤椎、非伤椎再骨折和相关并发症情况。结果单侧弥散组获随访12—16个月[（14．6±0．6）个月]；双侧弥散组获随访13—16个月[（15．2±0．2）个月]。单侧弥散组术后1个月和术后1年VAS分别为（3．0±O．4）分和（2．2±0．4）分，双侧弥散组分别为（2．1±0．4）分和（1．5±0．4）分。两组术后1个月和术后1年VAS与术前比较差异有统计学意义（P〈0．05），组间比较差异有统计学意义（P〈0．05）。单侧弥散组术后1个月和术后1年伤椎前缘高度压缩率分别为（15．2±3．9）％和（16．3±3．4）％，双侧弥散组分别为（15．6±3．5）％和（16．8±3．9）％；单侧弥散组术后1个月和术后1年伤椎矢状面Cobb角分别为（2．9±0．7）°和（3．0±0．6）°，双侧弥散组分别为（3．0±0．7）。和（3．2±0．7）°。两组术后1个月和术后1年伤椎前缘高度压缩率和伤椎矢状面Cobb角与术前比较差异有统计学意义（P〈0．05），组间比较差异无统计学意义（P〉0．05）。单侧弥散组伤椎再骨折率为6．9％，双侧弥散组为0（P〈0．05）。单侧弥散组非伤椎再骨折率为5．6％，双侧弥散组为5．5％（P〉0．05）。两组患者均未出现术中神经根损伤、脑脊液漏、肺栓塞、过敏性休克或术后感染。单侧弥散组出现骨水泥椎旁渗漏2例，双侧弥散组出现骨水泥椎体前方渗漏1例。结论相较骨水泥单侧弥散，双侧弥散的止痛效果更优，可降低伤椎再骨折发生率，且并未增加非伤椎再骨折的风险。
Objective To evaluate the effects of unilateral and bilateral diffusion of cement on osteoporotic vertebral compression fractures treated with percutaneous kyphoplasty （PKP）. Methods A retrospective case control study was conducted on the clinical data of 127 patients with single segment osteoporosis vertebral compression fracture （OVCF） treated by unilateral puncture PKP between July 2013 and July 2015. According to whether the diffusion of bone cement crossed the median, all cases with OVCF were divided into unilateral and bilateral diffusion groups. The unilateral diffusion group （72 cases） included 29 males and 43 females, with an average age of 69.5 ± 2.6 years （range, 63-76 years）. In terms of the injured segment, there were 38 cases of L1, 20 L2, 11 L3, two L4, and one L5. In the unilateral diffusion group, the preoperative visual analog score （VAS） was （ 7.8 ± 0.9 ） points, the preoperative anterior vertebral height compression ratio was （ 32.5 ± 6.3 ） %, and the preoperative Cobb＇s angle of the injured vertebra was （ 9.2 ± 1.3 ） °. The bilateral diffusion group （ 55 cases ） included 22 males and 33 females, with an average age of 71.2 ± 2.9 years （range, 61-80 years）. In terms of the injured segment, there were 32 cases of L1 , 13 L2, six L3 , three L4, and one L5. In the bilateral diffusion group, the preoperative VAS was （7.6 ± 0.9 ） points, the preoperative anterior vertebral height compression ratio was （34.5 ±5.8）%, and the preoperative Cobb＇s angle of the injured vertebra （9.8±1.5） °. The VAS, anterior vertebral height compression ratio of the injured vertebra, Cobb＇s angle of the injured vertebra, and injured and non-injured vertebra refracture 1 month and 1 year after operation were recorded. Results The patients were followed up for 12-16 months （ mean, 14.6 ±0.6 months ） in unilateral diffusion group and for 13- 16 months （mean, 15.2 ± 0.2 months） in bilateral diffusion group. The VAS score of the unilateral diffusion group was （3.0 ± 0.4） points at 1 month after the operation and （2.2 ± 0.4 ） points at 1 year after the operation, respectively. The VAS score of the bilateral diffusion group was （2.1 ± 0.4） points at 1 month after the operation and （ 1.5 ± 0.4 ） points at 1 year after the operation, respectively. The VAS score decreased significantly 1 year after operation compared with that before operation （ P 〈 0.05 ）, and significant difference was noted between two groups （ P 〈 0.05 ）. The anterior vertebral height compression ratio of the unilateral diffusion group was （ 15.2 ± 3.9 ） % at 1 month after the operation and （16.3 ±3.4）% at 1 year after the operation, respectively. The anterior vertebral height compression ratio of the bilateral diffusion group was （ 15.6 ± 3.5 ） % at 1 month after the operation and （16.8 ± 3.9 ）% at 1 year after the operation, respectively. The Cobb＇s angle of the injured vertebra of the unilateral diffusion group was （2.9 ±0.7 ）° at 1 month after the operation and （ 3.0 ± 0. 6 ） ° at 1 year after the operation, respectively. The Cobb＇s angle of the injured vertebra of the bilateral diffusion group was （ 3.0 ±0.7 ）° at 1 month after the operation and （ 3.2 ± 0.7 ） ° at 1 year after the operation, respectively. The anterior vertebral height compression ratio and Cobb＇s angle of the injured vertebra decreased significantly after surgery （ P 〈 0.05 ） , but no statistically significant differences were observed between two groups （ P 〉 0.05 ）. The injured vertebra refracture ratio was 6.9% in unilateral diffusion group and 0 in bilateral diffusion group. The non-injured vertebra refracture ratio was 5.6% in unilateral diffusion group and 5.5% in bilateral diffusion group. No nerve root injury, eerebrospinal fluid leakage, pulmonary embolism, anaphylaetic shock and postoperative infection were found in the two groups. Paravertebral bone cement leakage occurred in two cases of the unilateral diffusion group and anterior vertebral bone cement leakage occurred in one case of the bilateral diffusion group. Conclusion Compared with unilateral diffusion, bilateral diffusion of bone cement has better analgesic effect and can reduce the incidence of re fracture of injured vertebra, without increasing the risk of re-fracture of the non-injured vertebrae.
作者
沈凯
张胜利
谭祖键
杨阜滨
曹代桂
邓丽
Shen Kai;Zhang Shengli;Tan Zujian;Yang Fubin;Cao Daigui;Deng Li.(Department of Spine Surgery, Chongqing General Hospital, Chongqing 400013, China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2018年第6期527-533,共7页
Chinese Journal of Trauma
