【摘要】 目的比较3种不同入路经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗胸腰段椎体压缩性骨折的疗效。方法我院2015年9月~2017年8月对85例96椎因骨质疏松性椎体压缩性骨折(osteoporotic vertebral compression fractures,OVCFs)行PVP,根据手术入路的不同分为3组:单侧经椎弓根入路组(33例38椎)、双侧经椎弓根入路组(25例27椎)、单侧经椎弓根外入路组(27例31椎)。比较3组手术时间、骨水泥分布、骨水泥渗漏率、椎体后凸Cobb角及胸腰背疼痛视觉模拟评分(Visual Analogue Scale,VAS)。结果手术时间单侧经椎弓根外入路组<单侧经椎弓根入路组<双侧经椎弓根入路组[(35.0±5.6)min vs.(42.2±7.3)min vs.(50.5±5.8)min,P<0.05]。术后3组椎体后凸Cobb角、VAS评分均较术前有改善(P<0.05)。3组间骨水泥注入量及渗漏率无显著性差异(P>0.05),但单侧经椎弓根入路组骨水泥分布均匀情况比其他2组差(P<0.05)。3组间术前后椎体后凸Cobb角均无显著性差异(P>0.05)。3组间术前VAS评分无明显差异(P>0.05),术后1周双侧经椎弓根入路组(3.0±1.2)分,单侧经椎弓根外入路组(3.3±1.2)分,明显低于单侧经椎弓根入路组(3.9±1.0)分(P<0.05),术后6个月3组间无显著性差异(P>0.05)。结论双侧经椎弓根入路和单侧经椎弓根外入路早期疗效优于单侧经椎弓根入路,单侧经椎弓根外入路PVP由于手术时间更短,操作风险更小,更适用于胸腰段OVCFs。更多还原

【Abstract】 Objective To compare clinical effect among three different approaches for percutaneous vertebroplasty( PVP) in the treatment of thoracolumbar vertebral compression fractures. Methods A retrospective study was performed on 96 lesions of osteoporotic vertebral compression fractures( OVCFs) in 85 patients from September 2015 to August 2017 in our hospital. They were divided into three groups according to different surgical approaches for PVP: unipedicular approach group( 33 cases,38 vertebrae),bipedicular approach group( 25 cases,27 vertebrae),and unilateral extrapedicular approach group( 27 cases,31 vertebrae). The operation time,bone cement distribution,bone cement leakage rate,kyphosis Cobb ’s angle,and Visual Analogue Scale( VAS) were compared among the three groups. Results The operation time showed that unilateral extrapedicular approach group < unipedicular approach group < bipedicular approach group [( 35. 0 ± 5. 6) min vs.( 42. 2 ± 7. 3) min vs.( 50. 5 ± 5. 8) min,P < 0. 05]. After operation,the Cobb’s angle and VAS scores were improved as compared with preoperation among the three groups( P < 0. 05). There were no significant differences in bone cement injection volume and leakage rate among the three groups( P > 0. 05),but the distribution of bone cement was less uniform in the unipedicular approach group than those in the other two groups( P < 0. 05). There was no significant difference in the Cobb’s angle between the three groups before and after the operation( P > 0. 05). The preoperative VAS scores had no significant difference among the three groups( P > 0. 05). The VAS scores 1 week after surgery showed that bipedicular approach group( 3. 0 ± 1. 2) points and unilateral extrapedicular approach group( 3. 3 ± 1. 2) points were less than the unipedicular approach group [( 3. 9 ± 1. 0) points,P < 0. 05]. However,VAS scores had no significant difference at 6 months after operation( P > 0. 05). Conclusions In PVP for thoracolumbar OVCFs,the curative effect through bipedicular approach and unilateral extrapedicular approach is better than through unipedicular approach during early postoperative period. Unilateral extrapedicular approach is highly praised because of shorter operation time and smaller operation risk.更多还原