单、双侧入路经皮椎体后凸成形术治疗骨质疏松性胸椎骨折伴肋间痛的疗效比较

Comparison of the effects of the unilateral and the bilateral percutaneous kyphoplasty therapies in the treatment of the osteoporotic thoracic vertebral fracture with intercostal pain

目的比较单、双侧入路经皮椎体后凸成形术治疗骨质疏松性胸椎压缩性骨折(OVCF)伴肋间痛的临床效果。方法回顾性分析2016年9月—2019年9月在徐州市中心医院63例行经皮椎体后凸成形术治疗的OVCF患者的临床资料,其中男25例、女38例,年龄61~93岁。按照手术路径的不同分为单侧组36例和双侧组27例。观察两组患者的手术时间、注入骨水泥量、骨水泥渗漏率、椎体高度恢复率、术后Cobb角改善程度,以及并发症情况;比较术前及术后第1天、1个月、3个月腰背部和肋间疼痛视觉模拟评分法(VAS)和Oswestry功能障碍指数(ODI)等。结果两组患者年龄、性别、伤椎分布等基线资料比较,差异均无统计学意义(P值均>0.05)。单侧组手术时间、注入骨水泥量均少于双侧组,分别为(31.75±6.60)、(38.96±6.77)min和(4.07±0.52)、(5.65±0.51)mL,而术后骨水泥渗漏率(27.8%,10/36)则高于双侧组(7.4%,2/27),差异均有统计学意义(t=4.242、11.863,χ^(2)=4.152,P值均<0.05);两组椎体高度恢复率、术后伤椎Cobb角改善程度比较,差异均无统计学意义(P值均>0.05)。患者术后均获随访1~3个月。两组患者术中、术后均未见明显神经、脊髓损伤,以及穿刺血肿、感染等并发症。两组患者术后各随访时间点腰背部疼痛、肋间痛VAS评分、ODI均较术前改善,差异均有统计学意义(P值均<0.05)。术前、术后第1天、1个月、3个月腰背部疼痛VAS评分、ODI,两组比较差异均无统计学意义(P值均>0.05);肋间痛VAS评分、ODI比较,术后第1天、1个月双侧组均低于单侧组,差异均有统计学意义(P值均<0.05),术前和术后3个月两组差异均无统计学意义(P值均>0.05)。结论单、双侧入路经皮椎体后凸成形术治疗伴有肋间痛的OVCF,其止痛和恢复脊柱稳定性的效果相近,但双侧入路骨水泥渗漏率更低,术后早期缓解肋间痛更有效,是一种更加安全可靠的方法。

Objective This study aims to compare the clinical effects of the unilateral and the bilateral percutaneous kyphoplasty therapies for the treatment of osteoporotic thoracic compression fracture(OVCF)with intercostal pain.Methods A retrospective analysis was performed on the clinical data of 63 patients with OVCF(25 males and 38 females aged 61-93 years)undergoing percutaneous kyphoplasty in Xuzhou Central Hospital from September 2016 to September 2019.Patients were divided into the unilateral(36 cases)and the bilateral(27 cases)groups in accordance with the different surgical paths.The operative time,amount of injected bone cement,leakage rate of bone cement,recovery rate of vertebral height,improvement degree of postoperative Cobb Angle,and complications in the two groups were observed.The visual analog scale(VAS)scores and the Oswestry disability indices(ODI)preoperative and the first day,1 month,and 3 months postoperative were compared.Results No statistically significant difference between the two groups was observed in terms of baseline data,such as age,gender,and vertebral injury distribution(all P values>0.05).The amount of operating time and injection of bone cement of the unilateral group([31.75±6.60]min and[4.07±0.52]mL respectively)were significantly less than those of the bilateral group([38.96±6.77]min and[5.65±0.51]mL,respectively;t=4.242,11.863;all P values<0.05).The postoperative bone cement leakage rate of the unilateral group(27.8%,10/36)was significantly higher than that of the bilateral group(7.4%,2/27;χ^(2)=4.152,P<0.05).No statistically significant difference was observed between the two groups in terms of the recovery rate of the vertebral height and the improvement degree of the Cobb Angle in the injured vertebra after the operation(all P values>0.05).All patients were followed up for 1-3 months.No obvious complications,such as nerve injury,spinal cord injury,puncture hematoma,and infection,were found during and after the operation.The lower back pain,intercostal VAS score,and ODI of patients in the two groups significantly improved compared with those before surgery at each follow-up time point(all P values<0.05).The comparison of VAS scores and ODI of lower back pain between the unilateral and the bilateral groups showed no significant difference before and 1 day,1 month,and 3 months after the surgery(all P values>0.05).The comparison of VAS score and ODI of intercostal pain showed that both groups were significantly lower than the unilateral group 1 day and 1 month after surgery(all P values<0.05),and no significant difference was observed between the preoperative and the 3 months postoperative(all P values>0.05).Conclusions The unilateral and the bilateral transdermal kyphoplasty therapies for the treatment of OVCF with intercostal pain have similar analgesic and spinal stability recovery effects,but the bilateral approach,which is a safer and more reliable method,has lower bone cement leakage rate and is more effective in early postoperative relief of intercostal pain than the unilateral approach.