单、双侧椎弓根入路椎体成形术治疗骨质疏松椎体压缩性骨折的临床比较分析
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摘要
研究目的:通过比较分析单侧椎弓根入路与双侧椎弓根入路椎体成形术治疗骨质疏松性椎体压缩性骨折上的临床疗效及差异,探讨单侧椎弓根入路行椎体成形术的优势。
方法:回顾性分析自2008年6月至2010年10月于我院行经皮椎体成形术的骨质疏松性椎体压缩性骨折患者30例病例共31个病椎,且术后随访超过了6个月,按手术方式分为经单侧椎弓根入路和经双侧椎弓根入路二组:单侧椎弓根入路组16例17节椎体,男7例,女9例,年龄55~82岁,平均67.8岁。双侧椎弓根入路组14例14节椎体,男6例,女8例,年龄58~80岁,平均68.3岁。骨折椎体为T9至L3,术前影像学检查证实所有病例均为骨质疏松性压缩性骨折,患者均在“C”型臂X线机引导下,经皮穿刺完成手术,术前术后进行临床和影像学观测分析。观测指标包括:手术时间,术中透视次数,疼痛视觉模拟评分(VAS),活动能力评分,骨水泥渗漏情况等,统计比较两组数据结果。
结果:所有患者手术均顺利完成。单侧入路组平均手术时间为(40.52土16.8)min,术中透视次数为(12.65士3.24)次,疼痛视觉模拟评分(VAS)由术前的(7.6士1.8)分降至术后的(2.4士1.5)分,术后6个月为(2.6士1.3)分;活动能力评分术前平均为(2.82±0.73)分,术后改善至(1.32±0.31)分,术后6个月为(1.41±0.48)分。双侧入路组平均手术时间为(56.81士15.9)min;术中透视次数(22.32士4.58)次,疼痛视觉模拟评分(VAS)由术前的(7.8士1.7)分降至术后的(2.5士1.3)分,术后6个月为(2.6士1.2)分,活动能力评分术前平均为(2.76±0.81)分,术后改善至(1.20±0.44)分,术后6个月为(1.36±0.53)分。两组相比较,手术时间与术中透视次数两项指标,有统计学差异(P <0.05),单侧组及双侧组在VAS、活动能力评分两项指标上,手术前与手术后比较,其差异有统计学意义(P <0.05),术后与术后6个月比较,无统计学意义(P>0.05),在VAS缓解、活动能力评分改善上两组间比较差异无统计学意义(P>0.05)。单侧入路组发生椎体前方渗漏1例,双侧入路组发生椎体前方及侧方骨水泥渗漏各1例,无肺栓塞、脑栓塞及脊髓、神经根损伤等并发症发生。术后平均随访6个月。手术椎体无疼痛加剧,无迟发性神经损伤表现,未发现手术椎体高度丢失。
结论:经皮椎体形术是一种治疗老年人骨质疏松性椎体压缩骨折安全有效的微创方法,单侧椎弓根入路经皮椎体成形术在治疗骨质疏松性压缩性骨折不仅能达双侧椎弓根入路相同的手术效果,而且具有手术时间短、放射暴露少、创伤小,费用低等优点,所以单侧椎弓根入路的椎体成形术是治疗骨质疏松椎体压缩性骨折的可行及有效方法。
Objective: The purpose of this study is to investigate the advantage of unipedicular approach vertebroplasty by comparing the clinical efficacy and differences between unipedicular and bipedicular approach vertebroplasty in the treatment of osteoporotic vertebral compression fractures.
Methods: Totally 30 patients with 31 symptomatic vertebrae of osteoporotic vertebral compression fractures operated by vertebroplasty from June 2008 to October 2010 at the First Affiliated Hospital Of Shantou University were retrospectively analyses.All of them received more than 6 months’follow-up.They were divided into two groups on the basis of unilateral or bilateral of transpedicular operations.The unilateral group included of 7 men and 9 women with an average age of 67.8 (range from 55 to 82 years old).Only one vertebrate was involved in 15 cases,two vertebrates were involved in 1 cases. The bilateral group included of 6 men and 8 women, with an average age of 68.3 (range from 58 to 80 years old).Only one vertebrate was involved in all cases. The fracture of vertebral body was from T9 to L3, and it was confirmed that all cases were osteoporotic compression fractures by imaging studies preoperatively.All patients under the“C”type arm X-ray machine guided percutaneously finished the operation. Observation and analysis were conducted preoperatively and postoperatively. Observations included: surgical time, perspective times, visual analog pain score (VAS), activity ability score, and bone cement leakage. Statistical data results were compared between these two groups.
Results: All patients tolerated the operation well.The average surgical time was (40.52±16.8)min for unilateral group and the perspective times were (12.65±3.24). The VAS was reduced to (2.4±1.5) from (7.6±1.8) preoperatively, and was (2.6±1.3) after 6 months’follow-up. Activity ability scores increased to (1.32±0.31) from (2.82±0.73) preoperatively, and was (1.41±0.48) after 6 months’follow-up. The average surgical time was (56.81±15.9)min for bilateral group and the perspective times were(22.32±4.58). The VAS was reduced to (2.3±1.3) from (7.6±1.5) preoperatively, and was (2.6±1.2) after 6 months’follow-up. Activity ability score increased to (1.20±0.44) from (2.82±0.73) preoperatively, and was (1.36±0.53) after 6 months’follow-up. Compared with these two groups, the surgical time and the perspective times were statistical significance differences(P <0.05); the preoperative and postoperative of VAS and activity ability scores between these two groups were statistical significance differences(P <0.05), while the postoperative and the 6 months’follow-up were no statistical significance differences(P >0.05). The recovery rate of VAS and activity ability scores between these two groups were no statistical significance differences(P >0.05). There was 1 case occured cement leakage in front of the vertebral body in the unilateral group, and there were 1case occured cement leakage in front of the vertebral body and 1 case occured cement leakage beside the vertebral body in the bilateral group respectively. There was no case of pulmonary embolism, cerebral embolism, spinal cord or nerve root injury and other complications. A mean follow-up postoperatively is 6 months. There is no alleviate pain in the operated vertebral body, no manifestation of delayed nerve injury, and no height loss of the operated vertebral body.
Conclusion: Percutaneous vertebroplasty is a safe and effective minimally invasive method for treating osteoporotic vertebral compression fractures in elderly patients. Unipedicular approach vertebroplasty can not only achieve the same results of operations in the treatment of osteoporotic vertebral compression fractures, but also has the advantages of shorter surgical time, less radiation exposure, less trauma, and lower cost, so unipedicular approach vertebroplasty is a practical and effective method in the treatment of osteoporotic vertebral compression fractures.
方法:回顾性分析自2008年6月至2010年10月于我院行经皮椎体成形术的骨质疏松性椎体压缩性骨折患者30例病例共31个病椎,且术后随访超过了6个月,按手术方式分为经单侧椎弓根入路和经双侧椎弓根入路二组:单侧椎弓根入路组16例17节椎体,男7例,女9例,年龄55~82岁,平均67.8岁。双侧椎弓根入路组14例14节椎体,男6例,女8例,年龄58~80岁,平均68.3岁。骨折椎体为T9至L3,术前影像学检查证实所有病例均为骨质疏松性压缩性骨折,患者均在“C”型臂X线机引导下,经皮穿刺完成手术,术前术后进行临床和影像学观测分析。观测指标包括:手术时间,术中透视次数,疼痛视觉模拟评分(VAS),活动能力评分,骨水泥渗漏情况等,统计比较两组数据结果。
结果:所有患者手术均顺利完成。单侧入路组平均手术时间为(40.52土16.8)min,术中透视次数为(12.65士3.24)次,疼痛视觉模拟评分(VAS)由术前的(7.6士1.8)分降至术后的(2.4士1.5)分,术后6个月为(2.6士1.3)分;活动能力评分术前平均为(2.82±0.73)分,术后改善至(1.32±0.31)分,术后6个月为(1.41±0.48)分。双侧入路组平均手术时间为(56.81士15.9)min;术中透视次数(22.32士4.58)次,疼痛视觉模拟评分(VAS)由术前的(7.8士1.7)分降至术后的(2.5士1.3)分,术后6个月为(2.6士1.2)分,活动能力评分术前平均为(2.76±0.81)分,术后改善至(1.20±0.44)分,术后6个月为(1.36±0.53)分。两组相比较,手术时间与术中透视次数两项指标,有统计学差异(P <0.05),单侧组及双侧组在VAS、活动能力评分两项指标上,手术前与手术后比较,其差异有统计学意义(P <0.05),术后与术后6个月比较,无统计学意义(P>0.05),在VAS缓解、活动能力评分改善上两组间比较差异无统计学意义(P>0.05)。单侧入路组发生椎体前方渗漏1例,双侧入路组发生椎体前方及侧方骨水泥渗漏各1例,无肺栓塞、脑栓塞及脊髓、神经根损伤等并发症发生。术后平均随访6个月。手术椎体无疼痛加剧,无迟发性神经损伤表现,未发现手术椎体高度丢失。
结论:经皮椎体形术是一种治疗老年人骨质疏松性椎体压缩骨折安全有效的微创方法,单侧椎弓根入路经皮椎体成形术在治疗骨质疏松性压缩性骨折不仅能达双侧椎弓根入路相同的手术效果,而且具有手术时间短、放射暴露少、创伤小,费用低等优点,所以单侧椎弓根入路的椎体成形术是治疗骨质疏松椎体压缩性骨折的可行及有效方法。
Objective: The purpose of this study is to investigate the advantage of unipedicular approach vertebroplasty by comparing the clinical efficacy and differences between unipedicular and bipedicular approach vertebroplasty in the treatment of osteoporotic vertebral compression fractures.
Methods: Totally 30 patients with 31 symptomatic vertebrae of osteoporotic vertebral compression fractures operated by vertebroplasty from June 2008 to October 2010 at the First Affiliated Hospital Of Shantou University were retrospectively analyses.All of them received more than 6 months’follow-up.They were divided into two groups on the basis of unilateral or bilateral of transpedicular operations.The unilateral group included of 7 men and 9 women with an average age of 67.8 (range from 55 to 82 years old).Only one vertebrate was involved in 15 cases,two vertebrates were involved in 1 cases. The bilateral group included of 6 men and 8 women, with an average age of 68.3 (range from 58 to 80 years old).Only one vertebrate was involved in all cases. The fracture of vertebral body was from T9 to L3, and it was confirmed that all cases were osteoporotic compression fractures by imaging studies preoperatively.All patients under the“C”type arm X-ray machine guided percutaneously finished the operation. Observation and analysis were conducted preoperatively and postoperatively. Observations included: surgical time, perspective times, visual analog pain score (VAS), activity ability score, and bone cement leakage. Statistical data results were compared between these two groups.
Results: All patients tolerated the operation well.The average surgical time was (40.52±16.8)min for unilateral group and the perspective times were (12.65±3.24). The VAS was reduced to (2.4±1.5) from (7.6±1.8) preoperatively, and was (2.6±1.3) after 6 months’follow-up. Activity ability scores increased to (1.32±0.31) from (2.82±0.73) preoperatively, and was (1.41±0.48) after 6 months’follow-up. The average surgical time was (56.81±15.9)min for bilateral group and the perspective times were(22.32±4.58). The VAS was reduced to (2.3±1.3) from (7.6±1.5) preoperatively, and was (2.6±1.2) after 6 months’follow-up. Activity ability score increased to (1.20±0.44) from (2.82±0.73) preoperatively, and was (1.36±0.53) after 6 months’follow-up. Compared with these two groups, the surgical time and the perspective times were statistical significance differences(P <0.05); the preoperative and postoperative of VAS and activity ability scores between these two groups were statistical significance differences(P <0.05), while the postoperative and the 6 months’follow-up were no statistical significance differences(P >0.05). The recovery rate of VAS and activity ability scores between these two groups were no statistical significance differences(P >0.05). There was 1 case occured cement leakage in front of the vertebral body in the unilateral group, and there were 1case occured cement leakage in front of the vertebral body and 1 case occured cement leakage beside the vertebral body in the bilateral group respectively. There was no case of pulmonary embolism, cerebral embolism, spinal cord or nerve root injury and other complications. A mean follow-up postoperatively is 6 months. There is no alleviate pain in the operated vertebral body, no manifestation of delayed nerve injury, and no height loss of the operated vertebral body.
Conclusion: Percutaneous vertebroplasty is a safe and effective minimally invasive method for treating osteoporotic vertebral compression fractures in elderly patients. Unipedicular approach vertebroplasty can not only achieve the same results of operations in the treatment of osteoporotic vertebral compression fractures, but also has the advantages of shorter surgical time, less radiation exposure, less trauma, and lower cost, so unipedicular approach vertebroplasty is a practical and effective method in the treatment of osteoporotic vertebral compression fractures.
引文
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