改良一侧PKP联合对侧PVP与双侧PKP治疗骨质疏松性椎体压缩骨折的对比研究

A comparative analysis of modified PKP combined with contralateral PVP or bilateral PKP in the treatment of osteoporotic vertebral compression fractures

目的探讨同椎体一侧经皮椎体后凸成形术 (percutaneous kyphoplasty,PKP) 联合对侧经皮椎体成形术 (percutaneous vertebroplasty,PVP) 对治疗胸腰椎骨质疏松性椎体压缩骨折 (osteoporotic vertebral compression fractures,OVCFs) 的临床疗效。方法选择 2018 年 5~12 月收治的 67 例胸腰椎 OCVFs 患者。其中试验组 (改良一侧 PKP 联合对侧 PVP) 31 例,对照组 (传统双侧 PKP) 36 例。统计比较两组手术时间、术前与术后疼痛视觉模拟评分 (visual analogue scale,VAS)、骨水泥注入量和渗漏率、Cobb’s 角矫正情况以及椎体前缘和中部的高度变化,分析各项指标之间的差异是否具有统计学意义。结果所有患者术后症状均得到明显缓解,均未发生严重并发症。其中,试验组手术时间 (33.35±11.34) min,术前与术后 7 天 VAS 评分分别为 (7.60±2.34) 分和 (1.95±0.63) 分,椎体前缘高度分别为 (18.78±3.07) mm 和 (28.22±4.98) mm,椎体中部高度分别为 (19.21±4.35) mm 和 (30.82±3.31) mm,Cobb’s 角分别为 (26.84±4.79) °和 (13.66±3.13) °;对照组手术时间为 (42.10±12.26) min,术前与术后 7 天 VAS 评分分别为 (7.85±1.87) 分和 (2.11±0.45) 分,椎体前缘高度分别为 (20.31±4.76) mm 和 (26.76±2.21) mm,椎体中部高度分别为 (20.88±3.16) mm 和 (29.79±1.96) mm,Cobb’s 角分别为 (25.13±3.02) °和 (13.38±1.21) °。两组椎体前缘和中部高度、Cobb’s 角、VAS 评分术后与术前比较差异均有统计学意义 (P<0.05),但所有患者两侧缘高度改善率之间差异无统计学意义 (P>0.05)。组间比较,试验组手术操作时间低于对照组 (P<0.05),但椎体前缘和中部高度、Cobb’s 角度、VAS 评分的恢复改善差异无统计学意义 (P>0.05)。共有 9 例发生骨水泥渗漏 (试验组 5 例,对照组 4 例),渗漏率差异无统计学意义 (P>0.05)。结论改良一侧 PKP 联合对侧 PVP 与双侧 PKP 术式均能获得良好临床疗效。同时两种术式对疼痛改善程度、伤椎的复位效果以及骨水泥渗漏率方面差异无统计学意义,但改良一侧 PKP 联合对侧 PVP 在手术操作时间上明显优于双侧 PKP 术式。

Objective To evaluate the clinical efficacy of percutaneous kyphoplasty (PKP) combined with contralateral percutaneous vertebroplasty (PVP) in the treatment of thoracolumbar osteoporotic vertebral compression fractures (OCVFs).Methods Sixty-seven patients with OCVFs,who underwent surgery from May 2018 to December 2018,were enrolled.Among them,31 patients were in the experiment group (modified PKP combined with contralateral PVP) and 36 patients were in the control group (traditional bilateral PKP).Operation time,preoperative and postoperative visual analogue scale (VAS),bone cement injection volume and leakage rate,Cobb’s angle correction,and height changes of the anterior and middle vertebral bodies were statistically compared between the two groups.Results All patients had significant relief after surgery without any serious complications.Parameters of the experiment group before and 7 days after surgery:operation time (33.35±11.34) min;VAS scores[(7.60±2.34),(1.95±0.63),respectively];height of the anterior border of the vertebral body [(18.78±3.07) mm,(28.22±4.98) mm,respectively];height of the middle part of the vertebral body [(19.21±4.35) mm,(30.82±3.31) mm,respectively];Cobb’s angle [(26.84±4.79) °,(13.66±3.13) °,respectively].Parameters of the control group before and 7 days after surgery:operation time (42.10±12.26) min;VAS scores [(7.85±1.87),(2.11±0.45),respectively];height of the anterior border of the vertebral body [(20.31±4.76) mm,(26.76±2.21) mm,respectively];height of the middle part of the vertebral body [(20.88±3.16) mm,(29.79±1.96) mm,respectively];Cobb’s angle [(25.13±3.02) °,(13.38±1.21) °,respectively].Statistically significant differences were observed in the anterior and middle vertebral heights,Cobb’s angle,and VAS pre and post-operation (P < 0.05),while not in the improvement rate of the bilateral edge height (P > 0.05).Operation time of the experiment group was shorter than that of the control group with significant differences (P < 0.05).However,there were no significant differences in the improvement of the anterior and middle vertebral height,Cobb’s angle and VAS between the two groups (P > 0.05).Bone cement leakage was noted in 9 patients (5 in the experiment group and 4 in the control group),but with no significant differences (P > 0.05).Conclusions Modified PKP combined with contralateral PVP or bilateral PKP can both achieve good clinical results.No significant differences in the pain relief,reduction of the injured vertebrae and the rate of cement leakage are noticed.However,modified PKP combined with contralateral PVP is superior to the bilateral PKP in the operation time.