Chen Liang, Yang Hui-lin, Tang Tian-si
Department of Orthopaedic Surgery, Suzhou University, Suzhou 215006, China.
Zhonghua Wai Ke Za Zhi. 2009 Nov 1;47(21):1642-6.
To comparatively study the efficacy and safety of unilateral and bilateral balloon kyphoplasty in the treatment of painful multi-vertebral osteoporotic compression fractures.
From May 2002 to June 2007, 41 consecutive patients with painful multi-vertebral osteoporotic compression fractures underwent unilateral or bilateral kyphoplasty. The unilateral group included 3 male and 14 female with an average age of 70.4 (range 52 to 91 years old). The bilateral group included 4 men and 20 women with an average age of 72.4 (range 61 to 87 years old). Each procedure included insertion of inflatable balloon, fracture reduction and cement filling under "C"-arm monitoring. Preoperative and postoperative pain level, SF-36 score, radiographs and complications were recorded and analyzed.
All 41 patients tolerated the operation well. The mean operation time were (86 +/- 32) min and (120 +/- 26) min for unilateral and bilateral groups respectively; the mean volume of cement injected into one level were (3.9 +/- 1.6) ml and (5.4 +/- 2.1) ml for unilateral and bilateral groups respectively. The mean follow-up were (32.5 +/- 17.2) months and (30.7 +/- 14.3) months for unilateral and bilateral groups respectively. The mean VAS pain score of unilateral group decreased significantly from 7.4 +/- 2.1 preoperatively to 2.7 +/- 1.9 postoperatively (t = 2.50, P < 0.05) and 3.1 +/- 2.2 at final follow-up, the mean VAS pain score of bilateral group decreased significantly from 7.9 +/- 2.1 preoperatively to 2.3 +/- 2.5 postoperatively (t = 2.41, P < 0.05) and 2.7 +/- 2.2 at final follow-up, no significant difference was found between two groups. Significant increase of the mean height of anterior and medial vertebral body were recorded after the operation and maintained at final follow-up. The mean correction of local kyphosis was 7.2 degrees +/- 4.9 degrees for unilateral group and 7.3 degrees +/- 5.9 degrees for bilateral group, no significant difference was found between two groups. Postoperatively, 6 of 8 subscales measured by SF-36 were significantly improved for both groups. Complications were found in 7 patients including 6 cases of cement leakage and 1 case of pulmonary embolization.
As a minimally invasive procedure, unilateral or bilateral kyphoplasty is effective and relatively safe for multi-vertebral osteoporotic compression fracture.
比较单侧与双侧球囊后凸成形术治疗多节段骨质疏松性椎体压缩骨折的疗效与安全性。
2002年5月至2007年6月，41例连续的多节段骨质疏松性椎体压缩骨折伴疼痛患者接受了单侧或双侧后凸成形术。单侧组包括3例男性和14例女性，平均年龄70.4岁（范围52至91岁）。双侧组包括4例男性和20例女性，平均年龄72.4岁（范围61至87岁）。每例手术均在“C”形臂监测下进行球囊置入、骨折复位及骨水泥填充。记录并分析术前和术后的疼痛程度、SF-36评分、X线片及并发症。
41例患者手术耐受性均良好。单侧组和双侧组的平均手术时间分别为(86±32)分钟和(120±26)分钟；单侧组和双侧组每节段注入骨水泥的平均量分别为(3.9±1.6)毫升和(5.4±2.1)毫升。单侧组和双侧组的平均随访时间分别为(32.5±17.2)个月和(30.7±14.3)个月。单侧组VAS疼痛评分术前平均为7.4±2.1，术后显著降至2.7±1.9（t=2.50，P<0.05），末次随访时为3.1±2.2；双侧组VAS疼痛评分术前平均为7.9±2.1，术后显著降至2.3±2.5（t=2.41，P<0.05），末次随访时为2.7±2.2，两组间差异无统计学意义。术后椎体前缘和中部高度均值显著增加，并在末次随访时维持。单侧组局部后凸畸形平均矫正度为7.2°±4.9°，双侧组为7.3°±5.9°，两组间差异无统计学意义。术后，两组通过SF-36测量的8个分量表中有6个显著改善。7例患者出现并发症，包括6例骨水泥渗漏和1例肺栓塞。
作为一种微创手术，单侧或双侧后凸成形术治疗多节段骨质疏松性椎体压缩骨折有效且相对安全。
