摘要目的 分析单侧与双侧球囊扩张椎体后凸成形术(KP)治疗多椎体骨质疏松性压缩骨折的疗效.方法 对2002年5月至2007年6月,采用KP治疗并且获得1年以上随访的41例多椎体骨质疏松性压缩骨折患者,按手术是单侧或双侧进行分组.单侧手术组17例40个椎体,其中男性3例,女性14例;年龄52～91岁,平均70.4岁.双侧手术组24例53个椎体,其中男性4例,女性20例;年龄61～87岁,平均72.4岁.所有患者均在"C"型臂X线机引导下,经皮穿刺完成手术.术后观察症状改善、骨折复位及后凸矫正、并发症发生等情况,并进行统计学对比分析.结果 所有患者手术均顺利完成.单侧手术组平均手术时间(86±32)min,平均每椎体注射骨水泥(3.9±1.6)ml,术后平均随访(32.5±17.2)个月;双侧手术组平均手术时间(120±26)min,平均每椎体注射骨水泥(5.4±2.1)ml,术后平均随访(30.7±14.3)个月.疼痛VAS评分:单侧手术组术前为7.4±2.1,术后为2.7±1.9,末次随访为3.1±2.2,手术前后差异有统计学意义(P＜0.05);双侧手术组术前为7.9 ±2.1,术后为2.3±2.5,末次随访为2.7±2.2,手术前后差异有统计学意义(P＜0.05).两组术后椎体前缘、中部高度均比术前有显著增加,且维持至末次随访,差异均有统计学意义(P＜0.05).椎体后凸角单侧手术组平均矫正7.2°±4.9°,双侧手术组平均矫正7.3°±5.9°,各组手术前后比较,差异有统计学意义(P＜0.05).而两组间上述各指标对应比较,差异无统计学意义.两组术后SF-36生命质量调查表8个领域中有6个显著提高.41例中发生骨水泥渗漏6例,肺栓塞1例.结论 单侧或双侧KP治疗多椎体骨质疏松性压缩骨折均可获得满意的治疗效果.

abstractsObjective To comparatively study the efficacy and safety of unilateral and bilateral balloon kyphoplasty in the treatment of psinful multi-vertebral osteoporotic compression fractures.Methods From May 2002 to June 2007,41 consecutive patients with painful multi-vertebral osteoporotic compression fractures underwent unilateral or bilateral kyphoplasty.The unilateral group included 3 male and 14 female with an average age of 70.4 (range 52 to 91 years old).The bilateral group included 4 men and 20 women with an average age of 72.4 (range 61 to 87 years old).Each procedure included insertion of inflatable balloon.fracture reduction and cement filling under "C"-arm monitoring.Preoperative and postoperative pain level.SF-36 score,radiographs and complications were recorded and analyzed.Results All 41 patients tolerated the operation well.The mean operation time were (86±32) min and (120±26) min for unilateral and bilateral groups respectively;the mean volume of cement injected into one level were (3.9±1.6)ml and (5.4±2.1)ml for unilateral and bilateral groups respectively.The mean follow-up were (32.5±17.2)months and (30.7±14.3) months for unilateral and bilateral groups respectively.The mean VAS pain score of unilateral group decreased significantly from 7.4±2.1 preoperatively to 2.7 ±1.9postoperatively (t=2.50,P＜0.05)and 3.1±2.2 at final follow-up,the mean VAS pain score of bilateral group decreased significantly from 7.9±2.1 preoperatively to 2.3±2.5 postoperatively (t=2.41,P＜0.05)and 2.7±2.2 at final follow-up,no significant difference was found between two groups.Significant increase of the mean height of anterior and medial.vertebral body were recorded after the operation and maintained at final follow-uD.The mean correction of local kyphosis Was 7.2°±4.9°for unilateral group and 7.3°±5.9°for bilateral group,no significant difference was found between two groups.Postoperatively,6 of 8 subscales measured by SF-36 were significantly improved for both groups.Complications were found in 7 patients including 6 cases of cement leakage and 1 case of pulmonary embolization.Conclusion As a minimally invasive procedure,unilateral or bilateral kyphoplasty is effective and relatively safe for multivertebral osteoporotic compression fracture.