经皮椎体后凸成形术：双侧入路有必要吗？
Percutaneous Kyphoplasty: Is Bilateral Approach Necessary?
机构信息
Neurosurgery Department, Mustafa Kemal University, Hatay, Turkey.
Neurosurgery Department, Ataturk University, Erzurum, Turkey.
出版信息
Spine (Phila Pa 1976). 2018 Jul 15;43(14):977-983. doi: 10.1097/BRS.0000000000002531.
STUDY DESIGN
A multicenter retrospective study of patients who underwent unilateral and bilateral balloon kyphoplasty.
OBJECTIVE
The aim of this study was to compare the radiographic and clinical results of unilateral and bilateral balloon kyphoplasty to treat osteoporotic vertebral compression fractures.
SUMMARY OF BACKGROUND DATA
Percutaneous kyphoplasty has long been used as a successful method in the treatment of osteoporotic vertebral compression fractures. Although the bilateral approach is considered to be the mainstay application of percutaneous kyphoplasty, the unilateral approach has also been shown to be sufficient and even more effective in some cases.
METHODS
A total of 87 patients who underwent percutaneous kyphoplasty due to osteoporotic vertebral compression fractures between 2009 and 2016 were retrospectively evaluated and divided into two groups as patients who underwent unilateral or bilateral percutaneous kyphoplasty. Unilateral percutaneous kyphoplasty was performed in 36 and bilateral percutaneous kyphoplasty in 51 patients. The groups were compared in terms of clinical outcomes, radiological findings, and complications. Clinical outcomes were evaluated using Visual Analogue Scale and Oswestry Disability Index and the radiological findings were evaluated by comparing the preoperative and postoperative day 1 and year 1 values of anterior, middle, and posterior vertebral heights and kyphosis angle.
RESULTS
Clinical improvement occurred in both groups but no significant difference was observed. In radiological workup, no significant difference was found between the groups in terms of improvements in vertebral heights and kyphosis angle. Operative time and the amount of cement used for the surgery were significantly lower in the patients that underwent unilateral kyphoplasty.
CONCLUSION
Unilateral percutaneous kyphoplasty is as effective as bilateral percutaneous kyphoplasty both radiologically and clinically. Operative time and the amount of cement used for the surgery are significantly lower in unilateral kyphoplasty, which may play a role in decreasing complication rates.
LEVEL OF EVIDENCE
研究设计
一项多中心回顾性研究，纳入行单侧和双侧球囊扩张椎体后凸成形术的患者。
目的
本研究旨在比较单侧和双侧球囊扩张椎体后凸成形术治疗骨质疏松性椎体压缩骨折的影像学和临床结果。
背景资料概要
经皮椎体后凸成形术长期以来一直是治疗骨质疏松性椎体压缩骨折的成功方法。尽管双侧入路被认为是经皮椎体后凸成形术的主要应用，但在某些情况下，单侧入路也已被证明是足够且甚至更有效的。
方法
回顾性评估了 2009 年至 2016 年间因骨质疏松性椎体压缩骨折而行经皮椎体后凸成形术的 87 例患者，并将其分为行单侧或双侧经皮椎体后凸成形术的两组。单侧经皮椎体后凸成形术 36 例，双侧经皮椎体后凸成形术 51 例。比较两组的临床结果、影像学发现和并发症。临床结果采用视觉模拟评分法和 Oswestry 功能障碍指数进行评估，影像学结果通过比较术前和术后第 1 天及 1 年的椎体前缘、中部和后缘高度及后凸角的数值进行评估。
结果
两组均出现临床改善，但无显著差异。在影像学检查中，两组椎体高度和后凸角的改善无显著差异。单侧后凸成形术的手术时间和手术中使用的骨水泥量显著低于双侧后凸成形术。
结论
单侧经皮椎体后凸成形术在影像学和临床方面与双侧经皮椎体后凸成形术同样有效。单侧后凸成形术的手术时间和手术中使用的骨水泥量显著降低，这可能在降低并发症发生率方面发挥作用。
证据等级
3 级。
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