[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.
点击复制

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()
分享到:

《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.

参考文献/References:


[1] BOONEN S,WAHL DA,NAUROY L,et al.Balloon kyphoplasty and vertebroplasty in the management of vertebral compression fractures[J].Osteoporos Int,2011,22(12):2915-2934.
[2] 杨惠林,YUAN HA,陈亮,等.椎体后凸成形术治疗老年骨质疏松脊柱压缩骨折[J].中华骨科杂志,2004,23(5):262-265.
[3] 黄胜,许靖,项禹诚,等.单侧与双侧入路经皮椎体成形术治疗骨质疏松压缩性骨折的比较研究[J].中国矫形外科杂志,2013,21(2):115-118.
[4] 杨建平,谢国华,薛峰,等.单球囊单、双侧扩张经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折的比较[J].中医正骨,2014,26(3):21-24.
[5] 申勇,刘法敬,张英泽,等.单、双侧经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折的疗效[J].中国脊柱脊髓杂志,2011,21(3):202-206.
[6] 蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:123.
[7] 中国老年学学会骨质疏松委员会,骨质疏松症诊断标准学科组.中国人骨质疏松症诊断标准专家共识(第三稿·2014版)[J].中国骨质疏松杂志,2014,20(9):1007-1010.
[8] 王璐,赵琳,刘伯锋,等.胸椎椎弓根应用解剖对椎弓根钉置入方法的影响[J].中国老年学杂志,2013,33(18):4387-4390.
[9] BOUZA C,LPEZ-CUADRADO T,ALMENDRO N,et al.Safety of balloon kyphoplasty in the treatment of osteoporotic vertebral compression fractures in Europe:a meta-analysis of randomized controlled trials[J].Eur Spine J,2015,24(4):715-723.
[10] 谭中宝,狄镇海,张建,等.CT图像模拟穿刺路径在经皮椎体成形术中的应用价值[J].放射学实践,2012,27(9):998-1000.
[11] CHEN LH,HSIEH MK,LIAO JC,et al.Repeated percutaneous vertebroplasty for refracture of cemented vertebrae[J].Arch Orthop Trauma Surg,2011,131(7):927-933.
[12] 王想福,范有福,石瑞芳,等.单侧穿刺椎体后凸成形术骨水泥分布与穿刺角度的关系[J].中国骨伤,2015,28(8):704-707.
[13] ZHONG BY,WU CG,HE SC,et al.ANVCFV score system:assessment for probability of new vertebral compression fractures after percutaneous vertebroplasty in patients with vertebral compression fractures[J].Pain Physician,2015,18(6):1047-1057.
[14] PHILLIPS FM,TODD WETZEL F,LIEBERMAN I,et al.An in vivo comparison of the potential for extravertebral cement leak after vertebroplasty and kyphoplasty[J].Spine(Phila Pa 1976),2002,27(19):2173-2178.
[15] 鲁常胜,蒋涛,鲁婷玮,等.经皮椎体后凸成形术椎管内骨水泥渗漏的诊断及预防[J].临床骨科杂志,2017,20(1):30-33.
[16] 耿家金,赵平,牛和明,等.分次灌注骨水泥技术治疗骨质疏松性椎体压缩骨折疗效观察[J].中国骨与关节损伤杂志,2013,28(3):225-227.
[17] 王远政,田晓滨,李波,等.高粘度骨水泥与低粘度骨水泥经皮椎体成形术治疗严重骨质疏松性椎体压缩性骨折的前瞻性比较研究[J].中华创伤骨科杂志,2017,19(1):54-60.
[18] 郑毓嵩,张勇,林金丁,等.椎体成形术骨水泥渗漏的相关危险因素分析[J].中华创伤杂志,2015,31(4):312-316.
[19] TAYLOR RS,TAYLOR RJ,FRITZELL P.Balloon kyphoplasty and vertebroplasty for vertebral compression fractures—A comparative systematic review of efficacy and safety[J].Spine(Phila Pa 1976),2006,31(23):2747-2755.
[20] 陈建德,樊晓琦,夏炳江,凌义龙.球囊扩张部位对椎体后凸成形术治疗骨质疏松性椎体压缩骨折疗效及安全性的影响[J].中医正骨,2017,29(2):11-16.(收稿日期:2018-03-15 本文编辑:时红磊)

相似文献/References:

[1]张亮,张莉,王莉佳,等.快速康复外科理念在椎弓根螺钉内固定治疗 胸腰椎骨折围手术期护理中的应用[J].中医正骨,2015,27(06):75.
[2]潘雄,刘其顺,应行,等.中药联合4步康复锻炼法对骨质疏松性椎体压缩 骨折患者生存质量的影响[J].中医正骨,2015,27(04):65.
[3]宋永枝,陈双玲.唑来膦酸静脉滴注联合鲑降钙素肌肉注射治疗 骨质疏松性长骨骨折[J].中医正骨,2016,28(01):70.
[4]孙兰芬,王龙强,刘润宏,等.颈椎骨折脱位合并脊髓损伤截瘫患者的围手术期护理[J].中医正骨,2016,28(03):79.
[5]吴鹏,王博,孔令成,等.强骨饮颗粒联合阿仑膦酸钠维D3片口服在原发性骨质疏松性髋部骨折术后抗骨质疏松治疗中的应用[J].中医正骨,2016,28(05):16.
 WU Peng,WANG Bo,KONG Lingcheng,et al.Oral application of Qiangguyin Keli(强骨饮颗粒)and alendronate sodium Vitamin D3 tablets in postoperative anti-osteoporosis treatment in patients with primary osteoporotic hip fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(10):16.
[6]梅 伟.胸腰椎骨折临床诊疗中的热点问题[J].中医正骨,2016,28(07):1.
[7]徐无忌,刘晓岚.体位复位结合经皮椎体成形术与经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折的对比研究[J].中医正骨,2016,28(07):20.
 XU Wuji,LIU Xiaolan.Effect of Qianggu Yin(强骨饮,QGY)on bone microstructure in the ovariectomized osteoporosis rats[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(10):20.
[8]李英周,叶锋,王晓,等.后路撬拨植骨椎弓根螺钉内固定治疗胸腰椎骨折[J].中医正骨,2016,28(07):46.
[9]王军,陈哲,王硕凡.胸腰椎骨折椎体植骨材料的临床应用进展[J].中医正骨,2016,28(07):64.
[10]史晓林,王健,王博,等.脆性骨折的防治进展[J].中医正骨,2017,29(05):20.
[11]陈建德,樊晓琦,夏炳江,等.球囊扩张部位对椎体后凸成形术治疗骨质疏松性椎体压缩骨折疗效及安全性的影响[J].中医正骨,2017,29(02):11.
 CHEN Jiande,FAN Xiaoqi,XIA Bingjiang,et al.Influence of balloon dilation position on curative effect and safety of percutaneous kyphoplasty for treatment of osteoporotic vertebral compression fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(10):11.
[12]丁志清,颜峰,喻灿明,等.椎体后凸成形术后非典型骨水泥植入综合征死亡1例[J].中医正骨,2017,29(11):76.
[13]俞兴,王婷,杨济洲,等.经皮椎体成形术和经皮椎体后凸成形术治疗Kmmell病的对比研究[J].中医正骨,2018,30(06):23.
 YU Xing,WANG Ting,YANG Jizhou,et al.A retrospective trial of percutaneous vertebroplasty versus percutaneous kyphoplasty for treatment of Kmmell's diseases[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(10):23.
[14]彭小东,张晓刚,赵文韬,等.有限元分析在过伸复位治疗骨质疏松性椎体压缩性骨折生物力学研究中的应用进展[J].中医正骨,2018,30(07):25.
[15]于东方,王祥善,张华,等.经皮椎体成形术后手术椎体再骨折的病因、治疗及预防[J].中医正骨,2018,30(10):69.
[16]李兆勇,杨少锋,张晨阳.补肾活血方联合经皮椎体强化术治疗骨质疏松性椎体压缩骨折的系统评价[J].中医正骨,2019,31(03):28.
 LI Zhaoyong,YANG Shaofeng,ZHANG Chenyang.Oral application of Bushen Huoxue Fang(补肾活血方)combined with percutaneous vertebral augmentation for treatment of osteoporotic vertebral compression fractures:a systematic review[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(10):28.
[17]杨磊,崔宏勋,饶耀剑,等.弯角穿刺椎体成形装置辅助下单侧穿刺经皮椎体成形术治疗骨质疏松性椎体压缩骨折[J].中医正骨,2020,32(01):64.
[18]陈晨,安忠诚,张英健,等.椎体强化术后残留腰背痛的研究进展[J].中医正骨,2020,32(05):26.
[19]刘锐,龚德飞,班正涛,等.经皮椎体成形术治疗骨质疏松性椎体压缩骨折术中骨水泥渗漏的危险因素分析[J].中医正骨,2022,34(11):14.
 LIU Rui,GONG Defei,BAN Zhengtao,et al.Risk factors for bone cement leakage during percutaneous vertebroplasty treatment of osteoporotic vertebral compression fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(10):14.
[20]罗金金,丁彩田.骨质疏松性椎体压缩骨折经皮椎体后凸成形术后脊柱后凸畸形改善程度的影响因素分析[J].中医正骨,2022,34(08):8.
 LUO Jinjin,DING Caitian.Analysis of factors influencing the degree of improvement of spinal kyphosis deformity after percutaneous kyphoplasty for treatment of osteoporotic vertebral compression fracture[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(10):8.

更新日期/Last Update: 2019-02-25