目的：比较单侧与双侧经皮椎体后凸成形术(PKP)治疗陈旧性骨质疏松性椎体压缩性骨折的早中期临床效果和安全性。方法选择2008年3月~2012年11月于天津市第一中心医院治疗的46例陈旧性骨质疏松性单椎体胸腰椎压缩骨折患者，根据治疗方式不同，分为单侧组及双侧组。单侧组(20例)采用单侧椎弓根入路PKP治疗，双侧组(26例)采用双侧椎弓根入路PKP治疗。观察两组术前、术后3 d及末次随访时前中柱平均高度、Cobb角及视觉模拟疼痛评分(VAS)、Oswestry功能障碍指数评分(ODI)及并发症发生情况。结果所有患者均顺利完成手术。单侧组每个椎体手术时间为(43±11)min，每个椎体注射骨水泥为(2.9±0.7)mL；双侧组每个椎体手术时间为(64±11)min，每个椎体注射骨水泥为(4.1±1.1)mL，两组间每个椎体手术时间及骨水泥注射量的差异均有统计学意义(P<0.05)。两组术后及末次随访时椎体平均高度均较术前有所恢复，差异有统计学意义(P<0.05)，在上述两个时间点双侧组均优于单侧组，差异有统计学意义(P<0.05)。两组术后及末次随访时Cobb角均较术前降低，差异有统计学意义(P<0.05)，两组间比较差异无统计学意义(P>O.05)。两组术后及末次随访时VAS评分及ODI均较术前明显降低，差异有统计学意义(P<0.05)，两组间比较差异无统计学意义(P>O.05)。单侧组骨水泥渗漏发生率为10.0%，双侧组发生率为15.4%，差异有统计学意义(P<0.05)。单侧组2例出现伤椎邻近椎体再骨折，发生率为10.0%。结论单侧与双侧PKP治疗骨质疏松性陈旧性椎体压缩骨折安全有效，在早中期疼痛及活动能力方面改善率相似，相对于双侧手术，单侧具有手术时间短、骨水泥渗漏率低等优势。%Objective To compare and assess the clinical effect and safety in short and medium term of treating chronic OVCFs by unipedicular and bipedicular percutaneous kyphoplasty (PKP). Methods From March 2008 to November 2012, in the First Center Hospital of Tianjin City, 46 cases with sustained chronic painful osteoporotic single-vertebral compression fracture and underwent percutaneous kyphoplasty were selected and divided into unilateral group and bilateral group according to the treatment method. The unilateral group (20 cases) were given kyphoplasty via unipedicular approach and the bilateral group were given kyphoplasty via bipedicular approach. The vertebral body height, Cobb's angle, visual analogue scale (VAS), Oswestry disability index (ODI) at preoperation, postoperation 3 days, last follow-up and complications of two groups were observed. Results All patients were underwent surgery successfully. In the unilateral group, operative time of every vertelral bady were (43±11) min and bone cement filling of every vertelral bady were (2.9±0.7) mL, while those in the bilateral group were (64±11) min and (4.1±1.1) mL respectively, the differences were statistically significant (P< 0.05). The average of vertebral body height of two groups showed recovered after operation and at the last follow-up, the differences were statistically significant (P<0.05), and at the both two time, they of bilateral group were better than those of unilateral group, the differences were statistically significant (P< 0.05). The average of Cobb's of two groups showed recovered after operation and at the last follow-up, the differences were statistically significant (P< 0.05), but there was no statistically significant differences between two groups (P> 0.05). The VAS score and ODI were decreased significantly in two groups after operation and at the last follow-up, the differences were statistically significant (P< 0.05), but there was no statistically significant differences between two groups (P> 0.05). The cement leakage rate of unilateral group was 10.0%, and that of bilateral group was 15.4%, the difference was statistically significant (P<0.05). The rate of adjacent vertebral fractures was 10.0% (2 case) of unilateral group. Conclusion Both unipedicular and bipedicular PKP are safe and effective for chronic OVCFs, and they can achieve comparable results in pain relieve and functional recovery in short and medium term. The unipedicular approach has the advantages of shorter operation time and lower bone cement leakage rate.
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