Yan L, He B, Guo H, Liu T, Hao D
Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, China.
Osteoporos Int. 2016 May;27(5):1849-55. doi: 10.1007/s00198-015-3430-5. Epub 2015 Nov 25.
Many previous studies have reported excellent clinical results with percutaneous kyphoplasty (PKP). In contrast, numerous complications and problems have also been reported, such as puncture difficulty, cement leakage, and adjacent vertebral fracture.
This study is to evaluate the application and clinical outcomes of unilateral transverse process-pedicle and bilateral PKP in the treatment of osteoporotic vertebral compression fractures (OVCF).
A total of 56 cases with two levels thoracolumbar OVCF were randomly assigned for treatment with unilateral transverse process-pedicle and bilateral PKP. The patients were followed up postoperatively and were assessed mainly with regard to clinical and radiologic outcomes. Clinical outcomes were evaluated with mainly the use of a visual analogue scale (VAS) for pain. Radiologic outcomes were assessed mainly on the basis of radiation dose and bone cement distribution.
The operation was completed successfully in 56 cases. In the unilateral level, the operation time, the volume of the injected cement, and radiation dose were significantly less than bilateral level. All patients had significantly improvement on VAS score after the procedures, compared with their preoperative period. In the bilateral level, 7 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 effective treatments for patients with painful OVCF. But unilateral PKP received less radiation dose and operation time, offered a higher degree of deformity correction, and resulted in less complication than bilateral.
许多先前的研究报道经皮椎体后凸成形术(PKP)取得了出色的临床效果。相比之下,也有大量并发症和问题被报道,如穿刺困难、骨水泥渗漏和邻近椎体骨折。
本研究旨在评估单侧横突 - 椎弓根与双侧PKP在治疗骨质疏松性椎体压缩骨折(OVCF)中的应用及临床疗效。
总共56例患有两节胸腰椎OVCF的患者被随机分配接受单侧横突 - 椎弓根和双侧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评分法(VAS)评估疼痛情况。影像学结果主要根据辐射剂量和骨水泥分布进行评估。
56例手术均成功完成。在单侧节段,手术时间、注入骨水泥的体积和辐射剂量明显少于双侧节段。与术前相比,所有患者术后VAS评分均有显著改善。在双侧节段,7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,所有患者在末次随访时疼痛消失。
双侧和单侧PKP对于疼痛性OVCF患者而言都是相对安全有效的治疗方法。但单侧PKP接受的辐射剂量更少、手术时间更短,畸形矫正程度更高,并发症也比双侧更少。