单双侧椎弓根入路PKP治疗胸腰椎骨质疏松性压缩性骨折的对比分析

Comparative Analysis of Percutaneous Kyphoplasty With Unilateral and Bilateral Pedicle Approach for the Treatment of Osteoporotic Compression Fracture of Thoracolumbar Spine

目的比较单侧和双侧椎弓根入路经皮穿刺椎体后凸成形术治疗胸腰椎骨质疏松性压缩性骨折的临床效果。方法选取2017年6月-2019年6月本院收治的需要进行经皮椎体后凸形成术治疗胸腰椎压缩性骨折患者55例,按照手术入路不同分单侧入路组(n=29)和双侧入路组(n=26)。比较两组患者手术前后腰背部的疼痛程度;比较两组患者手术时间、术中出血量、骨水泥灌注量以及X线曝光次数;比较术前和术后Cobb角和椎体前缘高度,以及术后并发症情况,包括肺栓塞、骨水泥渗漏和伤椎邻近椎体再骨折。结果 (1)术前腰背部VAS评分比较差异无统计学意义(P> 0.05),术后两组患者VAS评分均有所下降,术后1天、术后3月两组之间VAS评分比较差异无统计学意义(P> 0.05)。(2)单侧入路组的手术时间、术中出血量、骨水泥灌注量及X线曝光次数均低于双侧入路组(P <0.05)。(3)术后均能改善术前患椎Cobb角及增加椎体前缘高度(P <0.05),术后单侧和双侧入路两组数据之间对比差异无统计学意义(P> 0.05)。单侧入路并发症发生率为13.79%,双侧入路组发生骨水泥侧漏6例、伤椎邻近椎体再骨折4例,并发症发生率为38.46%。单侧入路组并发症发生情况明显优于对照组(P <0.05)。结论单侧和双侧椎弓根入路经皮穿刺椎体后凸成形术均可有效缓解患者疼痛,改善病变椎体后凸畸形及恢复椎体高度,但单侧椎弓根入路较双侧可明显缩短手术时间,减少术中出血量、骨水泥灌注量、X线曝光次数以及术后并发症。

Objective To compare the clinical effect of percutaneous vertebroplasty for osteoporotic compression fracture of thoracolumbar spine. Methods From June 2017 to June 2019, 55 patients with thoracolumbar compression fracture who needed percutaneous kyphosis were selected and divided into two groups according to different surgical approaches: unilateral approach group(n = 29) and bilateral approach group(n = 26). Before and after the operation, the pain degree of the lumbar back was compared between the two groups;the operation time, intraoperative hemorrhage, bone cement perfusion and X-ray exposure times were compared between the two groups;the Cobb angle and the height of the anterior edge of the vertebral body were compared before and after the operation, as well as the postoperative complications, including pulmonary embolism, leakage of bone cement and re fracture of the vertebral body adjacent to the injured vertebral body. Results(1) there was no difference in VAS score between the two groups(P > 0.05), but there was no difference in VAS score between the two groups(P > 0.05).(2) the operation time, intraoperative bleeding volume, bone cement perfusion volume and X-ray exposure times of unilateral approach group were lower than those of bilateral approach group(P < 0.05).(3) the Cobb angle of the affected vertebrae and the height of the anterior edge of the vertebrae could be improved postoperatively(P < 0.05). The complication rate of unilateral approach was 13.79%. In bilateral approach group, there were 6 cases of cement leakage and 4 cases of vertebral re fracture near the injured vertebra, the complication rate was 38.46%. The incidence of complications in the unilateral approach group was significantly higher than that in the control group(P < 0.05). Conclusion percutaneous vertebroplasty with unilateral and bilateral pedicle approach can effectively alleviate the pain, improve the kyphosis of the diseased vertebral body and recover the height of the vertebral body. However, unilateral pedicle approach can significantly shorten the operation time, reduce the amount of intraoperative bleeding, the amount of bone cement infusion, the number of X-ray exposure and postoperative complications.