Yan Liang, Jiang Renqi, He Baorong, Liu Tuanjiang, Hao Dingjun
From the Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China.
Spine (Phila Pa 1976). 2014 Dec 15;39(26 Spec No.):B19-26. doi: 10.1097/BRS.0000000000000493.
A prospective comparative study.
To assess the clinical and radiological outcomes for the treatment of osteoporotic vertebral compression fractures using unilateral transverse process-pedicle and bilateral percutaneous kyphoplasty (PKP).
PKP is a widely used vertebral augmentation procedure for treating painful vertebral compression fractures. A percutaneous bilateral approach is typically used to access the vertebral body. Many previous studies have reported excellent clinical results with PKP. In contrast, numerous complications and problems have also been reported, such as puncture difficulty, cement leakage, and adjacent vertebral fracture.
This prospective study included 316 patients with single-level lumbar osteoporotic vertebral compression fracture, 224 females and 92 males with a mean age of 71.5 years. Randomized patients underwent PKP using 2 different puncture techniques. The patients were followed up postoperatively and were assessed mainly with regard to clinical and radiological outcomes. Clinical outcomes were evaluated mainly using the visual analogue scale for pain and 36-Item Short Form Health Survey (SF-36) questionnaire for health status. Radiological outcomes were assessed mainly on the basis of radiation dose, bone cement distribution, vertebral body height, and kyphotic angle.
Patients were followed up from 12 to 28 months, with an average of 16.8 months. One hundred fifty-eight patients were treated with unilateral method and 151 patients were treated with bilateral method. In the unilateral group, the volume of the injected cement and radiation dose were significantly less than that in the bilateral group. All patients in both groups had significantly less pain after the procedures, compared with their preoperative period pain. No statistically significant differences were observed when visual analogue scale and 36-Item Short Form Health Survey were compared between the groups. Both unilateral and bilateral groups showed insignificant decrease in the kyphotic angle during the follow-ups. The kyphotic angle in the unilateral group improved more significantly than in the bilateral group. In the bilateral group, 16 patients had obvious pain in the puncture sites at 1 month postoperatively caused by facet joint violation. With local block treatment, the pain disappeared in all patients at the last follow-up.
Both bilateral and unilateral PKP are relatively safe and provide effective treatment for patients with painful osteoporotic vertebral compression fracture. However, unilateral PKP received less radiation dose and operation time, it also offered a higher degree of deformity correction and resulted in less complication than bilateral PKP.
一项前瞻性对照研究。
评估使用单侧横突-椎弓根穿刺和双侧经皮椎体后凸成形术（PKP）治疗骨质疏松性椎体压缩骨折的临床和影像学结果。
PKP是一种广泛应用于治疗疼痛性椎体压缩骨折的椎体强化手术。通常采用经皮双侧入路进入椎体。许多先前的研究报道PKP取得了良好的临床效果。相比之下，也有大量并发症和问题被报道，如穿刺困难、骨水泥渗漏和相邻椎体骨折。
这项前瞻性研究纳入了316例单节段腰椎骨质疏松性椎体压缩骨折患者，其中女性224例，男性92例，平均年龄71.5岁。随机分组的患者采用两种不同的穿刺技术接受PKP治疗。术后对患者进行随访，主要评估临床和影像学结果。临床结果主要使用视觉模拟疼痛量表和健康状况36项简短健康调查问卷（SF-36）进行评估。影像学结果主要根据辐射剂量、骨水泥分布、椎体高度和后凸角进行评估。
患者随访时间为12至28个月，平均16.8个月。158例患者采用单侧方法治疗，151例患者采用双侧方法治疗。单侧组注入的骨水泥量和辐射剂量明显少于双侧组。两组所有患者术后疼痛均明显减轻，与术前疼痛相比差异有统计学意义。两组在视觉模拟量表和36项简短健康调查问卷方面比较，差异无统计学意义。单侧组和双侧组在随访期间后凸角均有轻微减小。单侧组后凸角改善比双侧组更明显。双侧组有16例患者术后1个月因小关节损伤在穿刺部位出现明显疼痛。经局部阻滞治疗，所有患者在最后一次随访时疼痛消失。
双侧和单侧PKP对疼痛性骨质疏松性椎体压缩骨折患者均相对安全且提供有效治疗。然而，单侧PKP接受的辐射剂量和手术时间更少，还能提供更高程度的畸形矫正，且并发症比双侧PKP更少。
