Abstract:

Objective　To compare the clinical outcomes of traditional unilateral or bilateral straight needle puncture vertebroplasty and unilateral corner puncture vertebroplasty in the treatment of thoracolumbar osteoporotic vertebral compression fractures (OVCFs). Methods　It was a randomized controlled trial. A total of 150 patients with OVCFs were diagnosed in Yiyang Central Hospital from November 2017 to December 2020. There were 66 males and 84 females; aged 65-92 years, with an age of (70.3±6.2) years old. They were divided into a unilateral straight needle puncture group, a bilateral straight needle puncture group, and a unilateral corner puncture group by the random number table method with 50 patients in each group. The operation time, radiation exposure time, intraoperative blood loss, postoperative first ambulation time, bone cement injection amount, bone cement distribution in the vertebral body, and Visual Analogue Scale (VAS) scores and Oswestry Disability Index (ODI) 1 month and 3 months after surgery were compared among the three groups. χ² test, rank sum test, and t test were used. Results　The operation time, radiation exposure time, intraoperative blood loss, and postoperative first ambulation time of the unilateral corner puncture group were all lower than those of the traditional unilateral or bilateral straight needle puncture group [(34.30±5.60) min vs. (58.26±4.34) min and (64.30±5.60) min, (5.28±2.21) min vs. (10.70±3.63) min and (15.98±4.20) min, (20.30±2.53) ml vs. (32.06±4.30) ml and (36.72±3.40) ml, (2.03±1.30) d vs. (3.54±4.17) d and (3.71±2.14) d], the bone cement distribution in the vertebral body was better than those of the traditional unilateral or bilateral straight needle puncture group, with statistically significant differences (all P<0.05). There was no statistically significant difference in the bone cement injection volume among the three groups (P>0.05). The VAS scores and ODI of the three groups 1 month and 3 months after surgery were significantly lower than those before surgery (all P<0.05), but there were no statistically significant differences among the three groups (all P>0.05). Conclusions　Unilateral corner puncture vertebroplasty may be beneficial to the patients' early postoperative rehabilitation compared with traditional straight needle puncture vertebroplasty. Long-term follow-up studies involving large sample are needed to further confirm our findings in order to support the clinical promotion of this technology.

Key words:

Thoracolumbar vertebral compression fractures, Unilateral corner puncture, Vertebroplasty, Bone cement

摘要：

目的　比较传统单侧或双侧直针穿刺椎体成形术和单侧拐角穿刺椎体成形术的临床疗效差异。方法　本研究为随机对照试验。将2017年11月至2020年12月益阳市中心医院确诊的150例骨质疏松性椎体压缩性骨折患者，其中男性66例，女性84例，年龄65～92（70.3±6.2）岁。使用随机数字表法分为单侧直针穿刺组、双侧直针穿刺组和单侧拐角穿刺组，每组各50例患者。比较3组患者在手术时间、辐射暴露时间、术中出血量、术后初次下地时间、骨水泥注入量、骨水泥在椎体分布情况以及术后1个月和术后3个月视觉模拟评分量表（VAS）评分和Oswestry功能障碍指数（ODI）差异。采用χ²检验、秩和检验、t检验。结果　单侧拐角穿刺组手术时间、辐射暴露时间、术中出血量、术后初次下地时间均少于传统单侧或双侧直针穿刺组［（34.30±5.60）min比（58.26±4.34）min、（64.30±5.60）min，（5.28±2.21）min比（10.70±3.63）min、（15.98±4.20）min，（20.30±2.53）ml比（32.06±4.30）ml、（36.72±3.40）ml，（2.03±1.30）d比（3.54±4.17）d、（3.71±2.14）d］，在骨水泥椎体分布上均优于传统单侧或双侧直针穿刺组，差异均有统计学意义（均P<0.05）。3组在骨水泥注入量上差异无统计学意义（P>0.05）。3组患者术后1个月和3个月的VAS评分和ODI均较术前显著降低（均P<0.05），但各组间差异均无统计学意义（均P>0.05）。结论　相对于传统直针穿刺椎体成形术，单侧拐角穿刺椎体成形术可能有利于患者术后早期康复，是否值得临床推广还需大样本远期随访数据进一步证实。

关键词:

胸腰椎压缩性骨折, 单侧拐角穿刺, 椎体成形术, 骨水泥