两种不同入路椎体成形术治疗腰椎骨质疏松性椎体压缩性骨折的临床疗效比较

Comparison of Clinical Efficacy between Two Different Approaches in Vertebroplasty for the Treatment of Osteoporotic Lumbar Vertebral Compression Fractures

摘要: 目的：探讨两种不同入路椎体成形术对腰椎骨质疏松性椎体压缩性骨折患者的疗效比较。方法：回顾性分析我院自2020年6月至2021年6月治疗的90例腰椎骨质疏松性椎体压缩性骨折的患者，随机分为实验组和对照组进行椎体成形术；实验组采用经单侧横突上缘椎弓根外入路，对照组采用经单侧椎弓根入路。随访1年以上，对比两组患者的手术时间、术中透视次数、骨水泥注入量、疼痛VAS评分、ODI评分，以评估患者功能恢复情况。结果：术前两组患者的一般资料差异无统计学意义。在手术时间和术中透视次数方面，实验组均少于对照组，差异有统计学意义(P < 0.05)；在骨水泥注入量方面两组患者差异无统计学意义(P > 0.05)；在疼痛VAS评分及功能障碍指数ODI评分中，两组患者随着随访时间的延长，评分均有所改善，差异无统计学意义(P > 0.05)。实验组、对照组分别有2例和3例发生骨水泥渗漏，均无症状性椎旁或椎间隙渗漏，无椎管内渗漏发生。结论：单侧横突上缘椎弓根外入路和单侧椎弓根入路术经皮椎体成形术治疗腰椎骨质疏松性椎体压缩性骨折效果均较好，前者手术时间更短，X线透视次数少。

Abstract: Purpose: To compare the efficacy of two different approaches to vertebroplasty in patients with lumbar osteoporotic vertebral compression fractures. Methods: A retrospective analysis of 90 patients with lumbar osteoporotic vertebral compression fractures treated from June 2020 to June 2021 were randomly divided into experimental group and control group for vertebroplasty; the experimental group used lateral pedicle approach, and the control group used unilateral pedicle approach. With a follow-up of more than 1 year, the operation time, intraoperative fluoroscopy times, cement injection volume, pain VAS score, and ODI score were compared to evaluate their functional recovery. Results: There was no significant difference in the general data between the two groups. In terms of operation time and intraoperative fluoroscopy, the experimental group was less than the control group, statistically significant (P < 0.05); there was no statistically significant difference in the amount of bone cement injected between the two groups (P > 0.05); in pain VAS score and dysfunction index ODI score, the scores improved with the follow-up time, not statistically significant (P > 0.05). There were 2 cases of bone cement leakage in the experimental group and 3 in the control group, none of which resulted in symptomatic paravertebral or intervertebral space leakage, and no intravertebral canal leakage occurred. Conclusion: Percutaneous vertebroplasty with unilateral transverse process and unilateral pedicle were better in the treatment of lumbar osteoporotic vertebral compression fracture, with the former having shorter operation time and less X-ray fluoroscopy.