微创医学

目的总结侧卧位下单侧椎间孔外入路在经皮椎体成形术（PVP）中的安全性、有效性。方法回顾性分析侧卧位下行PVP的40例胸腰椎新鲜压缩性骨折患者的临床资料，其中将采用单侧椎弓根入路行PVP的患者纳入对照组（20例），采用单侧椎间孔外入路行PVP的患者纳入观察组（20例），收集统计所有患者的手术情况（手术时间、术中放射线投照次数、术中并发症情况）、术前及术后2 d 的VAS评分、止痛药使用评分和运动能力评分，以及术后骨水泥充盈情况。结果40例患者均顺利完成手术，术中椎管内骨水泥少量渗漏3次，但无神经损伤、骨水泥渗漏继发椎管狭窄等并发症。两组患者完成每个椎体手术时间、术中放射线投照次数比较，差异无统计学意义（均P＞0.05）。术前及术后2 d,两组VAS评分、止痛药使用评分、运动能力评分比较，差异无统计学意义（均P＞0.05）。观察组骨水泥双侧充盈弥漫情况优于对照组（P＜0.05）。结论胸腰椎新鲜压缩性骨折患者在合并心肺等疾病不能耐受俯卧位手术时，选择侧卧位下单侧椎间孔外入路行PVP是安全有效的，与经椎弓根入路比较，其更容易达到骨水泥双侧充盈弥散，值得临床推广和应用。

ObjectiveTo summarize the safety and effectiveness of unilateral extraforaminal approach in the lateral decubitus position for percutaneous vertebroplasty (PVP). MethodsThe clinical data of 40 patients with fresh thoracolumbar vertebral compression fractures undergoing PVP in the lateral decubitus position were retrospectively analyzed, in which 20 patients undergoing PVP via unilateral vertebral pedicle approach were enrolled to the control group, whereas 20 patients undergoing PVP via unilateral extraforaminal approach were included in the observation group. Operative states (operation duration, intraoperative radiographic projection times, intraoperative complications), preoperative and two-day postoperative VAS scores, scores of painkillers usage, scores of exercise performance, as well as the states of postoperative bone cement filling were collected and recorded in all patients. ResultsThe operation was successfully completed in 40 patients, with three times of a small amount of intraspinal bone cement leakage during the operation. But no complication like nerve injury, secondary onset of spinal canal stenosis induced by the leakage of bone cement occurred. The operation duration of each vertebrae completed in patients, and intraoperative radiographic projection times in both groups had no statistically significant differences (all P＞0.05). The differences of preoperative and two-day postoperative VAS scores, scores of painkillers usage and exercise performance were not statistically significant (all P＞0.05). The observation group exhibited superior states of bilateral bone cement filling to compared with the control group (P＜0.05). ConclusionWhen patients with fresh thoracolumbar vertebral compression fractures complicated with cardiopulmonary diseases unable to tolerate surgery in the prone position, employing PVP via unilateral extraforaminal approach in the lateral decubitus position is safe and effective. Compared with the approach via vertebral pedicle, the approach mentioned above is easier to achieve bilateral filling dispersion of bone cement, and thus it is worthy of clinical promotion and application.