不同入路球囊扩张椎体后凸成形术治疗老年新鲜骨质疏松性椎体压缩性骨折的疗效对比

Comparison of the effects of different percutaneous kyphoplasty in the treatment of elderly patients with fresh osteoporotic vertebral compression fractures

目的探讨不同入路球囊扩张椎体后凸成形术(PKP)治疗老年新鲜骨质疏松性椎体压缩性骨折(OVCF)的临床效果。方法采用随机数字表法将100例老年新鲜OVCF患者分为对照组和观察组,各50例。对照组行双侧穿刺入路PKP术,观察组行单侧穿刺入路PKP术。观察两组患者手术时间、术中透视次数、术中骨水泥注射量及骨水泥渗漏、临近椎体再骨折、不良反应情况,比较术前1 d、术后1 d、术后半年及1年两组患者疼痛视觉模拟评分(VAS)、Oswestry腰椎功能障碍指数(ODI)评分、生活质量量表(SF-36)评分、椎体前缘高度、椎体中间高度及Cobb角。结果对照组手术时间、术中透视次数及骨水泥注入量均明显多于观察组(P<0.05);术后,两组VAS、ODI评分及Cobb角较术前均明显降低(P<0.05),SF-36评分及椎体前缘高度、椎体中间高度较术前明显提高(P<0.05),但两组间各指标比较差异均无统计学意义(P>0.05);观察组骨水泥总渗漏率为8.0%,与对照组的12.0%比较差异无统计学意义(P>0.05);术后随访1年中,观察组临近椎体再骨折发生率为2.0%,明显低于对照组的12.0%(P<0.05)。结论与双侧入路比较,单侧入路PKP术治疗老年新鲜OVCF在取得相同疗效的情况下手术时间更短,透视次数、骨水泥用量更少,再骨折发生率更低,安全可靠,值得临床推广应用。

Objective To investigate the effect of different percutaneous kyphoplasty （PKP） inthe treatment of elderly patients with fresh osteoporotic vertebral compression fractures （OVCF）.Methods A total of 100 patients with OVCF were randomly divided into control group （n=50） andobservation group （n =50）. The control group was treated with bilateral puncture PKP, and theobservation group was treated by PKP. The operation time, intraoperative fluoroscopy times,postoperative bone cement injection volume and bone cement leakage, adjacent vertebral fractures,adverse reaction were observed in two groups. The VAS, ODI, SF -36 score, the anterior height ofvertebral body, the height of vertebral body and the angle of Cobb were compared between the twogroups before operation and 1d, six months and 1 year after operation. Results The operation time,intraoperative fluoroscopy times and bone cement injection volume of the control group weresignificantly higher than those of the control group （P〈0.05）. After operation, the VAS, ODI score andCobb angle of two groups were significantly decreased compared with before operation （P〈0.05）, theSF -36 score, vertebral height, middle vertebral height increased obviously compared with beforeoperation （P〈0.05）, but there were no significant differences in the indicators between the two groups（P 〉0.05）. There was no significant difference in total leakage rate of bone cement between the observation group （8%） and the control group （12%） （P〉0.05）. During the follow-up of 1 year, theincidence rate of adjacent vertebral fractures in the observation group （2%） was significantly lower than12% in the control group （P〈0.05）. Conclusion Compared with the bilateral approach, unilateral PKPapproach in the treatment of elderly patients with fresh OVCF has shorter operation time, whileachieving the same effect under fluoroscopy, with less bone cement usage, refracture rate is lower, it issafe, reliable and worthy of clinical application.