[1]陈建德,樊晓琦,凌义龙.单侧椎弓根旁外侧入路与双侧椎弓根入路 经皮椎体后凸成形术治疗骨质疏松性胸椎 压缩性骨折的对比研究[J].中医正骨,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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单侧椎弓根旁外侧入路与双侧椎弓根入路 经皮椎体后凸成形术治疗骨质疏松性胸椎 压缩性骨折的对比研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期数:
2018年10期
页码:
19-29
栏目:
临床研究
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:
陈建德樊晓琦凌义龙
(浙江省绍兴市中医院,浙江 绍兴 312000)
Author(s):
CHEN JiandeFAN XiaoqiLING Yilong
Shaoxing Hospital of Traditional Chinese Medicine,Shaoxing 312000,Zhejiang,China
关键词:
骨质疏松性骨折 脊柱骨折 胸椎 椎体后凸成形术
Keywords:
osteoporotic fractures spinal fractures thoracic vertebrae kyphoplasty
摘要:
目的:比较单侧椎弓根旁外侧入路与双侧椎弓根入路经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松性胸椎压缩性骨折的临床疗效和安全性。方法:回顾性分析47例骨质疏松性胸椎压缩性骨折患者的病例资料,其中采用单侧椎弓根旁外侧入路PKP治疗22例(单侧组),采用双侧椎弓根入路PKP治疗25例(双侧组)。男12例,女35例; 年龄61~83岁,中位数68岁; 骨折椎体位于T61例、T71例、T84例、T92例、T1010例、T1115例、T1214例。比较2组患者的手术时间、骨水泥灌注量、胸腰背部疼痛视觉模拟量表(visual analogue scale,VAS)评分、椎体前缘高度及并发症发生情况。结果:①手术时间和骨水泥灌注量。单侧组手术时间短于双侧组[(37.18±7.06)min,(42.20±8.42)min,t=2.196,P=0.033],骨水泥灌注量少于双侧组[(3.89±0.67)mL,(4.78±0.84)mL,t=3.983,P=0.000]。②胸腰背部疼痛VAS评分。时间因素与分组因素不存在交互效应(F=0.219,P=0.804); 2组患者胸腰背部疼痛VAS评分比较,组间差异无统计学意义,即不存在分组效应(F=0.157,P=0.694); 手术前后不同时间点之间胸腰背部疼痛VAS评分的差异有统计学意义,即存在时间效应(F=524.723,P=0.000); 2组患者胸腰背部疼痛VAS评分随时间均呈降低趋势,且2组的降低趋势完全一致[(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椎体前缘高度。时间因素与分组因素不存在交互效应(F=6.416,P=0.130); 2组患者椎体前缘高度比较,组间差异无统计学意义,即不存在分组效应(F=0.332,P=0.567); 手术前后不同时间点之间椎体前缘高度的差异有统计学意义,即存在时间效应(F=7.265,P=0.008); 2组患者椎体前缘高度随时间均呈升高趋势,且2组的升高趋势完全一致[(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组均未出现肺栓塞、低氧血症等骨水泥植入综合征以及切口感染、血肿形成。单侧组4例出现骨水泥渗漏,其中侧前方渗漏1例、椎间盘渗漏2例、静脉丛渗漏1例; 1例出现伤椎邻近椎体骨折。双侧组10例出现骨水泥渗漏,其中侧前方渗漏8例、椎间盘渗漏2例; 1例出现肋间神经损伤,2例出现伤椎邻近椎体骨折。单侧组并发症发生率低于双侧组(χ2=4.243,P=0.039)。因骨水泥渗漏量少,未出现神经根症状,均未做特殊处理; 邻近椎体骨折者,再次行PKP治疗后治愈。结论:单侧椎弓根旁外侧入路与双侧椎弓根入路PKP治疗骨质疏松性胸椎压缩性骨折,均能缓解胸腰背部疼痛和恢复椎体高度,但前者较后者手术时间短、骨水泥灌注量少、并发症少。
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.

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更新日期/Last Update: 2019-02-25