中国医药导报
中國醫藥導報
중국의약도보
CHINA MEDICAL HERALD
2015年
2期
42-45
,共4页
经皮椎体后凸成形术%骨质疏松性椎体压缩骨折%单侧椎弓根%双侧椎弓根
經皮椎體後凸成形術%骨質疏鬆性椎體壓縮骨摺%單側椎弓根%雙側椎弓根
경피추체후철성형술%골질소송성추체압축골절%단측추궁근%쌍측추궁근
Percutaneous kyphoplasty%Osteoporotic vertebral compression fractures%Uni-Extrapedicular approach of vertebroplasty%Bipedicular approach of vertebroplasty
目的：比较经皮椎体后凸成形术(PKP)单侧与双侧椎弓根入路治疗骨质疏松性椎体压缩骨折的效果。方法选择2010年1月~2014年5月于浙江省金华市中医院住院并行手术治疗的骨质疏松性椎体压缩骨折患者68例。采用随机数字表将其分为单侧组(34例，41个椎体)和双侧组(34例，42个椎体)，分别采用单侧与双侧椎弓根入路进行PKP治疗。观察并比较两组患者手术时间、出血量和骨水泥灌注量及术后椎体压缩率、Cobb's角恢复情况、疼痛缓解情况及并发症的发生率。结果单侧组患者的手术时间、出血量和骨水泥灌注量[(46.64±9.71)min、(5.14±1.42)mL、(3.24±0.72)mL]均明显少于双侧组[(64.27±12.71)min、(7.29±1.78)mL、(4.38±0.94)mL]，差异有统计学意义(t=2.32、2.37、2.29，P<0.05)；术后1个月，两组患者椎体压缩率、Cobb's角和VAS评分[(22.84±4.43)%、(15.31±3.07)o、(2.72±0.49)分、(21.73±4.12)%、(14.87±2.95)o、(2.60±0.45)分]均较术前[(35.82±6.48)%、(24.26±5.17)o、(8.16±1.37)分、(36.07±7.05)%、(23.92±4.97)o、(7.92±4.97)分]明显改善，差异有统计学意义(t=2.31、2.34、4.07、2.41、2.37、4.15，P<0.05或P<0.01)，且两组患者改善幅度比较差异无统计学意义(P>0.05)；两组患者术中均未发生神经及脊髓损伤，单侧组和双侧组术后发生骨水泥渗漏5例和3例，两组患者术后并发症发生率比较差异无统计学意义(χ2=0.14，P>0.05)。结论单侧与双侧椎弓根入路PKP均是治疗骨质疏松性椎体压缩骨折安全有效的微创方法，两者在缓解腰背部疼痛、恢复椎体高度及Cobb's角上的疗效相当，前者的手术创伤小、手术时间短、出血量少和骨水泥灌注量相对较少，不增加术后并发症的发生率。
目的：比較經皮椎體後凸成形術(PKP)單側與雙側椎弓根入路治療骨質疏鬆性椎體壓縮骨摺的效果。方法選擇2010年1月~2014年5月于浙江省金華市中醫院住院併行手術治療的骨質疏鬆性椎體壓縮骨摺患者68例。採用隨機數字錶將其分為單側組(34例，41箇椎體)和雙側組(34例，42箇椎體)，分彆採用單側與雙側椎弓根入路進行PKP治療。觀察併比較兩組患者手術時間、齣血量和骨水泥灌註量及術後椎體壓縮率、Cobb's角恢複情況、疼痛緩解情況及併髮癥的髮生率。結果單側組患者的手術時間、齣血量和骨水泥灌註量[(46.64±9.71)min、(5.14±1.42)mL、(3.24±0.72)mL]均明顯少于雙側組[(64.27±12.71)min、(7.29±1.78)mL、(4.38±0.94)mL]，差異有統計學意義(t=2.32、2.37、2.29，P<0.05)；術後1箇月，兩組患者椎體壓縮率、Cobb's角和VAS評分[(22.84±4.43)%、(15.31±3.07)o、(2.72±0.49)分、(21.73±4.12)%、(14.87±2.95)o、(2.60±0.45)分]均較術前[(35.82±6.48)%、(24.26±5.17)o、(8.16±1.37)分、(36.07±7.05)%、(23.92±4.97)o、(7.92±4.97)分]明顯改善，差異有統計學意義(t=2.31、2.34、4.07、2.41、2.37、4.15，P<0.05或P<0.01)，且兩組患者改善幅度比較差異無統計學意義(P>0.05)；兩組患者術中均未髮生神經及脊髓損傷，單側組和雙側組術後髮生骨水泥滲漏5例和3例，兩組患者術後併髮癥髮生率比較差異無統計學意義(χ2=0.14，P>0.05)。結論單側與雙側椎弓根入路PKP均是治療骨質疏鬆性椎體壓縮骨摺安全有效的微創方法，兩者在緩解腰揹部疼痛、恢複椎體高度及Cobb's角上的療效相噹，前者的手術創傷小、手術時間短、齣血量少和骨水泥灌註量相對較少，不增加術後併髮癥的髮生率。
목적：비교경피추체후철성형술(PKP)단측여쌍측추궁근입로치료골질소송성추체압축골절적효과。방법선택2010년1월~2014년5월우절강성금화시중의원주원병행수술치료적골질소송성추체압축골절환자68례。채용수궤수자표장기분위단측조(34례，41개추체)화쌍측조(34례，42개추체)，분별채용단측여쌍측추궁근입로진행PKP치료。관찰병비교량조환자수술시간、출혈량화골수니관주량급술후추체압축솔、Cobb's각회복정황、동통완해정황급병발증적발생솔。결과단측조환자적수술시간、출혈량화골수니관주량[(46.64±9.71)min、(5.14±1.42)mL、(3.24±0.72)mL]균명현소우쌍측조[(64.27±12.71)min、(7.29±1.78)mL、(4.38±0.94)mL]，차이유통계학의의(t=2.32、2.37、2.29，P<0.05)；술후1개월，량조환자추체압축솔、Cobb's각화VAS평분[(22.84±4.43)%、(15.31±3.07)o、(2.72±0.49)분、(21.73±4.12)%、(14.87±2.95)o、(2.60±0.45)분]균교술전[(35.82±6.48)%、(24.26±5.17)o、(8.16±1.37)분、(36.07±7.05)%、(23.92±4.97)o、(7.92±4.97)분]명현개선，차이유통계학의의(t=2.31、2.34、4.07、2.41、2.37、4.15，P<0.05혹P<0.01)，차량조환자개선폭도비교차이무통계학의의(P>0.05)；량조환자술중균미발생신경급척수손상，단측조화쌍측조술후발생골수니삼루5례화3례，량조환자술후병발증발생솔비교차이무통계학의의(χ2=0.14，P>0.05)。결론단측여쌍측추궁근입로PKP균시치료골질소송성추체압축골절안전유효적미창방법，량자재완해요배부동통、회복추체고도급Cobb's각상적료효상당，전자적수술창상소、수술시간단、출혈량소화골수니관주량상대교소，불증가술후병발증적발생솔。
Objective To compare the curative effect of uni-extrapedicular approach and bipedicular approach of ver-tebroplasty by percutaneous kyphoplasty (PKP) on osteoporotic vertebral compression fractures (OVCFs). Methods 68 cases of patients with OVCFs, who were given the operational medical treatment in Jinhua Traditional Chinese Medicine Hospital of Zhejiang Province, during the period from January 2010 to May 2014, were selected, and divided into uni-extrapedicular group (34 cases, 41 vertebrae) and bipedicula group (34 cases, 42 vertebrae) by table of random number, and were given uni-extrapedicular approach and bipedicular approach of vertebroplasty by PKP respectively. The operation time, amount of bleeding, bone cement perfusion amount, postoperative vertebral compression rate, Cobb's angle recovery, pain relief condition and complication occurrence rate of patients in two groups were observed and compared as well. Results The operation time, amount of bleeding and bone cement perfusion amount of patients in uni-extrapedicular group [(46.64±9.71) min, (5.14±1.42) mL, (3.24±0.72) mL] were much shorter or less than those in bipedicula group [(64.27±12.71) min, (7.29±1.78) mL, (4.38±0.94) mL], the differences were statistically significant (t=2.32, 2.37, 2.29,P< 0.05). The vertebral compression rate, Cobb's angle recovery and VAS one month after operation [(22.84±4.43)%, (15.31±3.07)o, (2.72±0.49) score, (21.73±4.12)%、(14.87±2.95)o, (2.60±0.45) score] were greatly im-proved than before operation [(35.82±6.48)%, (24.26±5.17)o, (8.16±1.37) score, (36.07±7.05)%, (23.92±4.97)o, (7.92±4.97) score], the differences were statistically significant (t=2.31, 2.34, 4.07, 2.41, 2.37, 4.15, P< 0.05 or P< 0.01), and after comparing the improvement rates of patients in the two groups, there was no statistically significant differ-ences (P> 0.05). No nerve and spinal cord injury were appeared on patients in the two groups during the operation, while 5 cases and 3 cases of leakage of bone cement were appeared in uni-extrapedicular group and bipedicula group respectively after the operation. Comparing the complication occurrence rates of patients in the two groups after opera-tion, there was no statistically significant differences (χ2=0.14, P>0.05). Conclusion Both uni-extrapedicular approach and bipedicular approach of vertebroplasty by PKP are the safe and effective minimally invasive methods to treat OVCFs, which has the equivalent curative effect on the relief of back pain, and recovery of vertebral height and Cobb's angel, and compared with the latter, the former has smaller operation damage, shorter operation time, less amount of bleeding, less amount of bone cement perfusion and no increase of complication occurrence rate after operation.
