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  • Title: [Effectiveness of synchronous unilateral percutaneous kyphoplasty in the treatment of double noncontiguous thoracolumbar osteoporotic vertebral compression fractures].
    Author: Jiang W, Niu G, Zhou G, Liu T, Zhang Q, Liu L, Cheng J.
    Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2021 Sep 15; 35(9):1155-1160. PubMed ID: 34523281.
    Abstract:
    OBJECTIVE: To investigate the effectiveness of synchronous unilateral percutaneous kyphoplasty (PKP) in the treatment of double noncontiguous thoracolumbar osteoporotic vertebral compression fracture (OVCF). METHODS: Between December 2018 and September 2020, 27 patients with double noncontiguous thoracolumbar OVCF were treated by synchronous unilateral PKP. There were 11 males and 16 females, with an average age of 75.4 years (range, 66-92 years). The fractures were caused by falls in 22 cases and sprains in 5 cases. The time from injury to hospital admission was 0.5-7.0 days, with an average of 2.1 days. The fractured vertebrae located at T 9 in 2 cases, T 10 in 3 cases, T 11 in 10 cases, T 12 in 15 cases, L 1 in 12 cases, L 2 in 6 cases, L 3 in 4 cases, and L 4 in 2 cases. The volume of bone cement injected into each vertebral body, operation time, and intraoperative fluoroscopy times were recorded. Anteroposterior and lateral X-ray films of thoracolumbar spine were taken to observe the anterior height of the injured vertebra, the Cobb angle of kyphosis, and the diffusion and good distribution rate of bone cement in the thoracolumbar spine. Visual analogue scale (VAS) score and Oswestry disability index (ODI) were used to evaluate the pain and functional improvement. RESULTS: All operations completed successfully. The operation time was 34-70 minutes, with an average of 45.4 minutes. The intraoperative fluoroscopy was 21- 60 times, with an average of 38.6 times. The volume of bone cement injected into each vertebral body was 2-9 mL, with an average of 4.3 mL. All patients were followed up 6-21 months, with an average of 11.3 months. X-ray film reexamination showed that the anterior height of the injured vertebra and Cobb angle at each time point after operation were significantly improved than those before operation ( P<0.05), and there was no significant difference between different time points after operation ( P>0.05). The distribution of bone cement was excellent in 40 vertebral bodies, good in 13 vertebral bodies, and poor in 1 vertebral body, and the excellent and good rate was 98.1% (53/54). The pain of all patients significantly relieved or disappeared, and the function improved. The VAS score and ODI at each time point after operation were significantly lower than those before operation ( P<0.05), and there was no significant difference between different time points after operation ( P>0.05). CONCLUSION: For the double noncontiguous thoracolumbar OVCF, the synchronous unilateral PKP has the advantages of simple puncture, less trauma, less intraoperative fluoroscopy, shorter operation time, satisfactory distribution of bone cement, etc. It can restore the height of the vertebral body, correct the kyphotic angle, significantly alleviate the pain, and improve the function. 目的: 探讨同步单侧穿刺经皮椎体后凸成形术（percutaneous kyphoplasty，PKP）治疗胸腰椎跳跃型双节段骨质疏松性椎体压缩骨折（osteoporotic vertebral compression fracture，OVCF）的疗效。. 方法: 2018 年 12 月—2020 年 9 月，采用同步单侧穿刺 PKP 治疗 27 例胸腰椎跳跃型双节段 OVCF。其中男 11 例，女 16 例；年龄 66～92 岁，平均 75.4 岁。致伤原因：摔伤 22 例，扭伤 5 例。受伤至入院时间 0.5～7.0 d，平均 2.1 d。骨折椎体节段：T 9 2 个，T 10 3 个，T 11 10 个，T 12 15 个，L 1 12 个，L 2 6 个，L 3 4 个，L 4 2 个。记录手术时间、术中透视次数、单节段椎体骨水泥注入量；摄胸腰椎正侧位 X 线片，观测伤椎椎体前缘高度、脊柱后凸 Cobb 角、骨水泥在胸腰椎体内弥散分布情况及分布优良率；以疼痛视觉模拟评分（VAS）及 Oswestry 功能障碍指数（ODI）评价患者疼痛和功能改善情况。. 结果: 手术均顺利完成。手术时间 34～70 min，平均 45.4 min；术中透视 21～60 次，平均 38.6 次；单节段椎体骨水泥注入量为 2～9 mL，平均 4.3 mL。患者均获随访，随访时间 6～21 个月，平均 11.3 个月。X 线片复查示术后各时间点椎体前缘高度及后凸 Cobb 角均较术前改善，差异有统计学意义（ P<0.05）；术后各时间点间比较差异均无统计学意义（ P>0.05）。椎体骨水泥分布达优 40 个椎体、良 13 个椎体、差 1 个椎体，优良率达 98.1%（53/54）。术后疼痛均明显缓解或消失，功能改善，术后各时间点 VAS 评分及 ODI 均较术前降低，差异有统计学意义（ P<0.05）；术后各时间点比较，差异均无统计学意义（ P>0.05）。. 结论: 采用同步单侧穿刺 PKP 治疗胸腰椎跳跃型双节段 OVCF 具有穿刺简便、创伤小、术中透视次数少、手术时间短及骨水泥分布满意等优点，术后椎体高度恢复及后凸角度矫正良好，疼痛明显缓解、功能显著改善。.
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