不同骨水泥注入修复方式行经皮椎体后凸成形术对老年骨质疏松性胸腰椎压缩骨折的疗效对比

Effect of different cement injection and repair methods on percutaneous kyphoplasty for elderly patients with osteoporotic thoracolumbar vertebral compression

目的分析不同骨水泥注入修复方式行经皮椎体后凸成形术(PKP)对老年骨质疏松性胸腰椎压缩骨折(OVCF)的疗效。方法遵义市第一人民医院脊柱外科2015年1月-2018年1月收治138例拟行PKP的老年OVCF患者,根据随机数字表法分为两组,分别采用单侧和双侧骨水泥注入修复治疗,各组69例。其中单侧组男性18例,女性51例;年龄65~80岁,平均71.47岁;病程3~21d,平均6.28d;责任椎体:T6~1232例,L1~537例。双侧组男性20例,女性49例;年龄65~80岁,平均70.47岁;病程2~24d,平均7.01d;责任椎体:T6~1234例,L1~535例。随访12个月,记录手术时间、X线照射次数、骨水泥注入量、术后住院时间,观察椎体前缘高度、中部高度及后凸Cobb角,比较两组并发症发生情况及不同时间点的视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)。结果单侧组手术时间、X线照射次数、骨水泥注入量均明显少于双侧组,差异均有统计学意义(P<0.05);两组术后住院时间、术前和术后6个月的椎体前缘高度、中部高度及后凸Cobb角比较,差异均无统计学意义(P>0.05)。单侧组骨水泥渗漏发生率为9.09%,明显低于双侧组的23.44%,差异均有统计学意义(P<0.05);两组穿刺损伤发生率和临近椎体再骨折发生率差异均无统计学意义(P>0.05);两组术前及术后1、6个月的VAS评分、ODI指数比较,差异均无统计学意义(P>0.05);两组组内比较,术后各时间点较术前差异均有统计学意义(P<0.05),但术后各随访时间点比较,差异均无统计学意义(P>0.05)。结论PKP单侧与双侧骨水泥注入修复治疗老年OVCF均可获得满意效果,前者在缩短手术时间、减小骨水泥注入量和减少骨水泥渗漏发生上具有优势,值得进一步推广。

Objective To analyze the effect of unilateral and bilateral cement injections on percutaneous kyphoplasty(PKP)for senile patients with osteoporotic thoracolumbar vertebral compression fracture(OVCF).Methods Totally 138 elderly patients with OVCF received PKP from Jan.2015 to Jan.2018,and were randomly divided into unilateral group and bilateral group,with 69 cases in each group.Patients in the unilateral groups were treated with unilateral bone cement injection,and patients in the bilateral group were treated with bilateral bone cement injection.In the unilateral group,there were 18 males and 51 females aged from 65-80(average,71.47)years.The course of injury was 3-21(average,6.28)days.The injured vertebra was T6-12 in 32 cases and L1-5 in 37 cases.In the bilateral group,there were 20 males and 49 females aged from 65-80(average,70.47)years.The course of injury was 2-24(average,7.01)days.The injured vertebra was T6-12 in 34 cases and L1-5 in 35 cases.After 12 months of follow-up,the perioperative information,bone cement injection,and postoperative hospitalization time were recorded.Vertebral body height,central height and kyphosis Cobb angle were used as observation indicators.The visual analogue scale(VAS)and Oswestry dysfunction index questionnaire(ODI)were compared between the two groups.Results The operation time in the unilateral group was significantly shorter than that of the bilateral group,the number of X-ray exposures and bone cement injection were significantly less than that of the bilateral group,and the difference was statistically significant(P<0.05);there was no difference in the postoperative hospital stay(P>0.05).There was no significant difference in vertebral body height,central height and kyphosis Cobb angle between the two groups before operation and after 6 months(P>0.05).The incidence of bone cement leakage in unilateral group was 9.09%,which was significantly lower than 23.44%in bilateral group,with statistically significant differences(P<0.05).There was no significant difference in the incidence of puncture injury and the incidence of adjacent vertebral fractures between the two groups(P>0.05);comparison of VAS score and ODI index before operation and 1 month and 6 months after surgery showed no significant difference within groups and between before and after operation(P>0.05),but had no significant difference at different follow-up time points(P>0.05).Conclusion PKP unilateral and bilateral bone cement injection repair can achieve satisfactory results in the treatment of elderly OVCF,but the former technique has advantages in shortening the operation time,reducing the amount of injected bone cement and reducing the occurrence of bone cement leakage,which is worthy of further promotion.