摘要
目的 探讨经症状轻重侧入路单侧穿刺经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗老年骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)的临床疗效。方法 回顾分析2020年6月—2021年6月收治且符合选择标准的100例症状偏于一侧的OVCF患者临床资料。按PVP操作时骨水泥穿刺入路分为症状较重侧入路组(A组)和症状较轻侧入路组(B组),每组50例。两组患者性别构成、年龄、身体质量指数、骨密度、损伤节段、病程及合并慢性疾病等一般资料比较差异均无统计学意义(P>0.05);B组操作侧椎体侧缘高度高于A组(P<0.001)。术前、术后1 d及1、3、12个月时,分别使用疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评价两组患者疼痛程度和脊柱运动功能。结果 两组患者术中、术后均无骨水泥过敏、发热,切口感染,一过性低血压等并发症发生;A组有4例发生骨水泥渗漏(3例椎间隙渗漏、1例椎旁渗漏),B组有6例发生骨水泥渗漏(4例椎间隙渗漏、1例椎旁渗漏、1例椎管渗漏),均无神经症状。两组患者均获随访,随访时间12~16个月,平均13.3个月。骨折均愈合,愈合时间2~4个月,平均2.9个月。患者在随访过程中无感染、邻椎骨折、血管栓塞等并发症发生。术后3个月,A、B组操作侧椎体侧缘高度均较术前显著改善,A组手术前后差值显著高于B组,差异均有统计学意义(P<0.05)。两组患者术后各时间点VAS评分和ODI均较术前显著改善,术后随时间延长进一步改善(P<0.05)。两组术前VAS评分和ODI比较差异均无统计学意义(P>0.05);术后1 d、1个月和3个月A组VAS评分和ODI均优于B组(P<0.05),术后12个月两组间差异无统计学意义(P>0.05)。结论 OVCF患者症状较重侧的椎体压缩更严重,PVP术中经症状较重侧注入水泥,术后早期疼痛缓解效果更佳,功能恢复更好。
Objective To explore the effectiveness of unilateral percutaneous vertebroplasty(PVP) through mild side and severe side approaches in the treatment of elderly osteoporotic vertebral compression fracture(OVCF).Methods The clinical data of 100 patients with OVCF with symptoms on one side who were admitted between June 2020 and June 2021 and met the selection criteria were retrospectively analyzed. The patients were divided into the severe side approach group(group A) and the mild side approach group(group B) according to the cement puncture access during PVP, with 50 cases in each group. There was no significant difference between the two groups in terms of general information such as gender composition, age, body mass index, bone density, damaged segments, disease duration, and chronic comorbidities(P>0.05). The lateral margin height of the vertebral body on the operated side in group B was significantly higher than that of group A(P<0.001). The pain level and spinal motor function were evaluated using the pain visual analogue scale(VAS) score and Oswestry disability index(ODI) before operation, at 1 day, 1 month,3 months, and 12 months after operation in both groups, respectively. Results No intraoperative or postoperative complications such as bone cement allergy, fever, incision infection, and transient hypotension occurred in both groups.Four cases of bone cement leakage occurred in group A(3 cases of intervertebral leakage and 1 case of paravertebral leakage), and 6 cases of bone cement leakage occurred in group B(4 cases of intervertebral leakage, 1 case of paravertebral leakage, and 1 case of spinal canal leakage), and none of them had neurological symptoms. Patients in both groups were followed up 12-16 months, with a mean of 13.3 months. All fractures healed and the healing time ranged from 2 to4 months, with a mean of 2.9 months. The patients had no complication related to infection, adjacent vertebral fracture, or vascular embolism during follow-up. At 3 months postoperatively, the lateral margin height of the vertebral body on the operated side in groups A and B were improved when compared with preoperative ones, and the difference between preand post-operative lateral margin height of the vertebral body in group A was higher than that in group B, all showing significant differences(P<0.001). The VAS scores and ODI in both groups improved significantly at all postoperative time points when compared with those before operation, and further improved with time after operation(P<0.05). The differences in VAS scores and ODI between the two groups before operation were not significant(P>0.05);VAS scores and ODI in group A were significantly better than those in group B at 1 day, 1 month, and 3 months after operation(P<0.05), but no significant difference was found between the two groups at 12 months after operation(P>0.05).Conclusion Patients with OVCF have more severe compression on the more symptomatic side of the vertebral body,and patients with PVP have better pain relief and better functional recovery when cement is injected through the severe symptomatic side.
作者
徐辉
杨俊松
刘团江
贺宝荣
柴鑫
郝定均
XU Hui;YANG Junsong;LIU Tuanjiang;HE Baorong;CHAI Xin;HAO Dingjun(Xi’an Medical University,Xi'an Shaanxi,710068,P.R.China;Department of Spine Surgery,Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University,Xi'an Shaanxi,710054,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2023年第2期168-173,共6页
Chinese Journal of Reparative and Reconstructive Surgery
基金
国家自然科学基金重点项目(81830077)。
关键词
经皮椎体成形术
骨质疏松性椎体压缩骨折
椎体侧缘高度
单侧椎弓根入路
Percutaneous vertebroplasty
osteoporotic vertebral compression fracture
lateral margin height of vertebral body
unilateral pedicle approach
