文章摘要
单侧与双侧PVP治疗骨质疏松性椎体压缩骨折临床疗效比较及骨水泥渗漏的危险因素分析
Clinical Efficacy Comparison of Unilateral and Bilateral PVP in the Treatment of Osteoporotic Vertebral Compression Fractures and Analysis of Risk Factors of Bone Cement Leakage
投稿时间:2023-01-06  修订日期:2023-01-06
DOI:
中文关键词: 单侧  双侧  经皮椎体成形术  骨质疏松性椎体压缩骨折  骨水泥渗漏  危险因素
英文关键词: Unilateral  Bilateral  Percutaneous vertebroplasty  Osteoporotic vertebral compression fractures  Bone cement leakage  Risk factors
基金项目:广元市指导性科技计划项目(19ZDYF0059);四川省卫生计生委科研课题(18PJ1184)
作者单位邮编
乔俊 广元市第一人民医院 628017
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中文摘要:
      目的:比较单侧与双侧经皮椎体成形术(PVP)治疗骨质疏松性椎体压缩骨折(OVCF)的临床疗效,并分析骨水泥渗漏的危险因素。方法:回顾性分析2019年5月~2020年12月期间本院收治的205例OVCF患者的临床资料,根据入路方式的不同分为单侧组和双侧组,例数分别为104例和101例。对比两组围术期指标、视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、Cobb’s角和椎体前缘高度,记录两组骨水泥渗漏及其他并发症发生情况,采用单因素及多因素Logistic回归分析骨水泥渗漏的影响因素。结果:与双侧组相比,单侧组手术时间缩短,骨水泥注入量、术中透视次数减少(P<0.05)。两组术前、术后3个月、末次随访时VAS、ODI评分均呈下降趋势(P<0.05)。与术前相比,两组术后3个月及末次随访时的椎体前缘高度均升高,Cobb’s角均缩小(P<0.05)。两组并发症发生率组间对比无统计学差异(P>0.05)。PVP患者骨水泥渗漏与骨水泥黏度、皮质断裂、骨折严重程度、骨折位置、年龄、CT值、骨水泥注入量有关(P<0.05)。骨水泥渗漏的危险因素主要有骨水泥注入量>6ml、骨折严重程度为重度、CT值>63HU、骨水泥黏度为低、皮质断裂(P<0.05)。结论:单侧与双侧PVP治疗OVCF效果相当。其中单侧可减少骨水泥注入量,缩短手术时间,减轻术后疼痛,促进术后功能恢复。而PVP手术最常见的并发症为骨水泥渗漏,受到骨折严重程度、皮质断裂、骨水泥黏度等因素的影响。
英文摘要:
      Objective: To compare the clinical efficacy of bilateral and unilateral percutaneous vertebroplasty (PVP) in the treatment of osteoporotic vertebral compression fracture (OVCF), and to analyze the risk factors of bone cement leakage. Methods: The clinical data of 205 patients with OVCF who were treated in our hospital from May 2019 to December 2020 were retrospectively analyzed. According to different approaches, they were divided into unilateral group and bilateral group, with 104 cases and 101 cases respectively. The perioperative indexes, visual analogue scale (VAS), Oswestry dysfunction index (ODI), Cobb''s angle and anterior vertebral height were compared between the two groups. The incidence of bone cement leakage and other complications were recorded. The influencing factors of bone cement leakage were analyzed by univariate and multivariate Logistic regression. Results: Compared with the bilateral group, the operation time, the bone cement injection volume and the number of intraoperative fluoroscopy in the unilateral group were shorter (P<0.05). The VAS and ODI scores of the two groups decreased before operation, 3 months after operation and at the last follow-up (P<0.05). Compared with that before operation, the height of the anterior edge of the vertebral body in the two groups increased at 3 months after operation and at the last follow-up, and the Cobb''s angle decreased (P<0.05). There was no significant difference in the incidence of complications between the two groups (P>0.05). Bone cement leakage in patients with PVP was related to bone cement viscosity, cortical fracture, fracture severity, fracture location, age, CT value and bone cement injection volume (P<0.05). The main risk factors of bone cement leakage were bone cement injection > 6ml, severe fracture severity, CT value > 63HU, low bone cement viscosity and cortical fracture (P<0.05). Conclusion: Unilateral PVP is equivalent to bilateral PVP in the treatment of OVCF. Unilateral PVP can reduce the bone cement injection volume, shorten the operation time, reduce postoperative pain and promote the recovery of postoperative function. The most common complication of PVP is bone cement leakage, which is affected by fracture severity, cortical fracture, bone cement viscosity and other factors.
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