单侧与双侧入路椎体成形术治疗老年骨质疏松性椎体压缩骨折的有限元分析及临床应用

目的 探讨单、双侧经皮椎体成形术(percutaneous vertebroplasty, PVP)治疗老年骨质疏松性胸腰椎椎体压缩性骨折的生物力学特点及临床疗效。方法 建立有限元模型模拟分析单、双侧椎弓根入路PVP术后椎体的应变及应力变化。回顾性研究接受单、双侧椎弓根入路PVP治疗老年骨质疏松性椎体压缩骨折患者85例，分析两组间手术时间、术中透视次数、骨水泥注射量、骨水泥渗漏率以及所有阶段视觉模拟量表（visual analogue scale, VAS）评分。结果有限元分析表明，单侧入路模型最大应变、应力分别是双侧入路模型的1.18倍、1.15倍；临床研究发现，单侧入路组手术时间、术中透视次数均明显少于双侧入路组(P<0.001)。两组骨水泥注射量、骨水泥渗漏率以及所有阶段VAS评分比较均无统计学意义(P>0.05)。结论 单侧入路椎体成形术生物力学效果与双侧入路接近；利用穿刺针定位单侧PVP治疗老年骨质疏松性胸腰椎椎体压缩性骨折与双侧入路PVP相比具有手术时间短、X线暴露次数少的特点。
Objective To investigate the biomechanical properties and clinical effects of the unilateral/bilateral percutaneous vertebroplasty (PVP) on the treatment of osteoporotic vertebral compression fractures in elderly patients. Methods The finite element models of the unilateral/bilateral percutaneous vertebroplasty (PVP) in osteoporotic vertebral compression fractures were established to evaluate changes in strain and stress of the fractured vertebra after surgery. Eighty patients with osteoporotic vertebral compression fractures underwent unilateral or bilateral PVP were collected for retrospective analysis. The operation time,intraoperative fluoroscopy times,injected bone cement volume, bone cement leakage rate and visual analogue scales (VAS) score between the two groups were analyzed. Results The maximum strain and stress in unilateral PVP group were 1.18 times and 1.15 times of those in bilateral PVP group,respectively.The operation time and intraoperative fluoroscopy times in unilateral PVP group were obviously smaller than those in bilateral PVP group (P<0.001). There was no statistical significance in the injected bone cement volume, bone cement leakage rate, and VAS score between the two groups (P>0.05).Conclusions The biomechanical effect of unilateral PVP was similar to that of bilateral PVP. The puncture needle localization of unilateral PVP for treating elderly patients with osteoporotic vertebral compression fractures had the advantage of less operation time and limited X-ray exposure.