微创医学

【摘要】目的分析单侧经皮椎体成形术（PVP）治疗胸椎骨质疏松性压缩骨折（OVCF）的可行性。方法100例胸椎OVCF患者随机分为单侧组（n=50）和双侧组（n=50），分别行单侧、双侧PVP术治疗。观察和记录两组手术操作情况及住院费用，评估术后疼痛程度，术后测量Cobb角、伤椎中间高度恢复情况，并统计并发症发生率。结果与双侧组相比，单侧组每个椎体手术时间显著较短，每个椎体骨水泥注入量、术中透视次数及住院费用显著较少，差异均有统计学意义（P＜0.05）。两组术后1周视觉模拟疼痛（VAS）评分比较，差异无统计学意义（P＞0.05）；术后3周、3个月两组VAS评分均明显降低，且单侧组VAS评分均显著低于双侧组，差异均有统计学意义（P＜0.01）。两组术前Cobb角、伤椎中间高度压缩率比较，差异无统计学意义（P＞0.05）；术后1周均较术前显著降低，并均较好地维持至6个月（P＜0.05），但两组术后1周、6个月Cobb角、伤椎中间高度恢复情况比较，差异无统计学意义（P＞0.05）。单侧组、双侧组并发症发生率分别为6.00%（3/50）、20.00%（10/50），差异有统计学意义（P＜0.05）。结论单侧PVP术治疗胸椎OVCF可取得双侧手术同样的疗效，但与双侧手术相比，单侧PVP术操作时间短，椎体骨水泥注入量、透视次数少，术后后疼痛程度更轻，安全性高，因此具有更高可行性。

【Abstract】 ObjectiveTo analyze the feasibility of unilateral percutaneous vertebroplasty (PVP) in the treatment of thoracic osteoporotic vertebral compression fractures (OVCF). MethodsOne hundred patients undergoing thoracic OVCF were randomly divided into unilateral group (n=50) and bilateral group (n=50). The unilateral group and bilateral group underwent unilateral and bilateral PVP respectively. The operative procedure and hospitalization expense of both groups were recorded. The degree of postoperative pain was evaluated, and the Cobb angle and the medium height improvement of injured vertebra were measured after operation. The incidence rate of complications was statistically analyzed. ResultsThe operative duration for each vertebral body, the injection volume of bone cement of each vertebral body, times of intraoperative Xray and hospitalization expense were significantly less in the unilateral group compared to the bilateral group(P＜0.05).There was no significant difference in the Visual Analogue Scale(VAS) between the two groups at 1 week after operation (P＞0.05). At 3 weeks and 3 months after operation, the VAS of both groups decreased significantly, and the VAS of the unilateral group were significantly lower than those of the bilateral group (P＜0.01).There were no significant differences in the Cobb angle and compression rate of medium height of injuried vertebra between the two groups before operation (P＞0.05) , but those indices above significantly decreased at 1 week after operation and maintained well for 6 months (P＜0.05). There were no significant differences in the Cobb angle and improvement of medium height of injured vertebra between the two groups at 1 week and 6 months after operation (P＞0.05).There was significant difference in the incidence rate of complications between the two groups［6.00%（3/50）vs. 20.00%（10/50）,P＜0.05］. ConclusionUnilateral PVP for thoracic OVCF can achieve the same effect as bilateral PVP. Thus, unilateral PVP is more feasible compared with bilateral PVP due to shorter procedure time, less injected volume of bone cement and Xray times, milder postoperative pain and higher safety.