弯角与传统单、双侧椎体成形术治疗老年骨质疏松性椎体压缩骨折

Analysis of the effect difference between the traditional single and bilateral vertebroplasty and bending angle in the treatment of osteoporotic vertebral compression fractures

目的探讨经皮弯角椎体成形术(PCVP)与传统单、双侧经皮椎体成形术(PVP)治疗老年骨质疏松性椎体压缩骨折(OVCF)的临床效果。方法选取2018年12月~2020年12月简阳市人民医院收治的OVCF患者126例,分为A组(42例,采用传统双侧PVP手术治疗)、B组(42例,采用传统单侧PVP手术治疗)和C组(42例,采用PCVP手术治疗)。记录3组手术时间、出血量、术中透视次数、骨水泥注入量、术后住院时间及骨水泥分布优良率、渗漏率。分别于术前及术后1、12周时采用疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评估3组疼痛及腰椎功能改善情况。比较3组术前及术后1、12周时伤椎相对高度,并对比3组术后1、12周Cobb角恢复率。结果3组术后住院时间、骨水泥渗漏率比较差异无统计学意义(P>0.05);A组手术时间显著长于B、C组(P<0.05),出血量、术中透视次数、骨水泥注入量显著高于B、C组(P<0.05),B、C组手术时间、出血量、术中透视次数、骨水泥注入量比较差异无统计学意义(P>0.05);A、C组骨水泥分布优良率显著高于B组(P<0.05),但A、C组骨水泥分布优良率比较差异无统计学意义(P>0.05)。3组术后1、12周VAS评分、ODI指数均显著低于术前(P<0.05),3组术前及术后1、12周VAS评分、ODI指数组间比较差异无统计学意义(P>0.05)。3组术后1、12周伤椎相对高度均显著高于术前(P<0.05),3组术前及术后1、12周伤椎相对高度比较差异无统计学意义(P>0.05),术后1、12周伤椎Cobb角恢复率比较差异无统计学意义(P>0.05)。结论采用PCVP手术治疗OVCF临床疗效可靠,其同时兼具传统单侧PVP手术时间较短、术中透视次数较少、术中出血量少、骨水泥注入量较低及传统双侧PVP手术骨水泥分布较为理想的优点,且均匀强化靶椎体,确保骨折椎体及脊柱稳定性。

Objective To study the clinical effect of percutaneous kyphoplasty(PCVP)and traditional unilateral and bilateral percutaneous vertebroplasty(PVP)in the treatment of osteoporotic vertebral compression fractures(OVCF).Methods 126 patients with OVCF in our hospital from December 2018 to December 2020 were selected and randomly divided into three groups,group A(42 cases,treated with traditional bilateral PVP operation),group B(42 cases,treated with traditional unilateral PVP operation)and group C(42 cases,treated with PCVP operation).The operative time,blood loss,intraoperative fluoroscopy times,bone cement injection volume,postoperative hospital stay,excellent and good rate of bone cement distribution and leakage rate of the three groups were recorded.Visual analogue scale(VAS)and Oswestry dysfunction index(ODI)were used to evaluate the pain and the improvement of lumbar function before operation and 1,12 weeks after operation.The relative height of injured vertebrae before operation and at 1 and 12 weeks after operation were compared among the three groups,and the recovery rate of Cobb angle at 1 and 12 weeks after operation were compared among the three groups.Results There was no significant difference in postoperative hospital stay and bone cement leakage rate among the three groups(P>0.05).The operative time of group A was significantly longer than that of group B and C(P<0.05),and the amount of blood loss,intraoperative fluoroscopy and bone cement injection in group A were significantly higher than those in group B and C(P<0.05),while there was no statistical significance in the operative time,blood loss,intraoperative fluoroscopy and bone cement injection in group B and C(P>0.05).VAS score and ODI index of the three groups at 1 and 12 weeks after surgery were significantly lower than those before surgery(P<0.05).There was no significant difference in VAS score and ODI index among the three groups before and 1 and 12 weeks after operation(P>0.05).The relative height of injured vertebrae 1 and 12 weeks after operation in three groups was significantly higher than that before operation(P<0.05).There was no statistically significant difference in the relative height of injured vertebrae among the three groups before and 1 and 12 weeks after surgery(P>0.05),and there was no statistically significant difference in the recovery rate of injured vertebrae Cobb Angle 1 and 12 weeks after surgery(P>0.05).Conclusion The clinical efficacy of PCVP in the treatment of OVCF is reliable.At the same time,it has the advantages of short operation time of traditional unilateral PVP,fewer intraoperative fluoroscopy times,lower intraoperative blood loss and bone cement injection volume,as well as ideal bone cement distribution of traditional bilateral PVP,and can strengthen the target vertebral body uniformly to ensure the stability of fractured vertebral body and spine.