双侧PKP与双侧PVP治疗急性单节段骨质疏松性椎体压缩性骨折疗效对比研究

Efficacy of bilateral percutaneous kyphoplasty versus bilateral percutaneous vertebroplasty in treatment of acute single-segment osteoporotic vertebral compression fractures

目的:回顾性分析双侧经皮椎体后凸成形术(PKP)与双侧经皮椎体成形术(PVP)治疗单节段急性骨质疏松性椎体压缩性骨折(OVCF)的临床治疗效果。方法:按纳入与排除标准筛选出2018年8月至2020年12月广州医科大学附属第三医院脊柱外科采用双侧PVP/PKP治疗的81例(共81个椎体)单节段急性OVCF患者,按治疗术式分为:试验组(双侧PKP组,n_(1)=36)和对照组(双侧PVP组,n_(2)=45)。评估两组手术操作时间、总透视次数、术中出血量、骨水泥注入量、术前、术后Oswestry功能障碍指数(ODI)及术前、术后3天、末次随访视觉模拟评分(Visual Analogue Score,VAS)评分、术前、术后伤椎前缘(AVBH)、中线高度(MVBH)、后缘高度(PVBH)及伤椎椎体局部Cobb角改善情况、骨水泥渗漏类型及渗漏率、术后伤椎椎体再发骨折及邻椎椎体新发骨折情况。结果:81例患者均顺利完成手术治疗,术中未出现骨水泥肺栓塞、截瘫等严重并发症。两组患者术后均获得随访,随访时间3~16个月,平均6个月。实验组与对照组术后3天、末次随访VAS评分、ODI指数相较术前明显改善(均P<0.05)。实验组术后伤椎椎体前缘高度(AVBH)、中线高度(MVBH)、后缘高度(PVBH)与对照组相比,差异具有统计学意义(均P<0.05);术后伤椎椎体Cobb角组间对比,差异具有统计学意义(均P<0.05);各组术后的伤椎椎体前缘高度(AVBH)、中线高度(MVBH)、后缘高度(PVBH)及伤椎椎局部Cobb角相较术前均改善明显(均P<0.05)。结论:双侧PKP与双侧PVP都能快速有效缓解单节段急性骨质疏松性椎体压缩性骨折患者疼痛症状,与双侧PVP相比,双侧PKP能尽早恢复伤椎椎体体高度、明显改善伤椎椎体局部Cobb角,有效纠正脊柱矢状面失衡状态。

Objective:To retrospectively analyze the clinical efficacy of bilateral percutaneous kyphoplasty(PKP)versus bilateral percutaneous vertebroplasty(PVP)in the treatment of acute single-segment osteoporotic vertebral compression fractures(OVCF).Methods:According to the inclusion and exclusion criteria,81 patients with acute single-segment OVCF(81 vertebrae in total)treated with bilateral PVP/PKP in the Department of Spine Surgery,Third Affiliated Hospital of Guangzhou Medical University between August 2018 and December2020 were included in the study.According to the treatment method,all patients were divided into the study group(bilateral PKP group,n_(1)=36)and control group(bilateral PVP group,n_(2)=45).The operative time,tota fluoroscopy times,intraoperative blood loss,bone cement injection,pre-operative and post-operative Oswestr dysfunction index(ODI),visual analogue score(VAS)at baseline,at 3d after the operation and at the fina follow-up,pre-operative and post-operative anterior vertebral body height(AVBH),middle vertebral body heigh(MVBH),posterior vertebral body height(PVBH),improvement of local Cobb angle of injured vertebral body,type and leakage rate of bone cement leakage,post-operative recurring fractures of injured vertebrae and new onset fractures of adjacent vertebrae in the two groups were evaluated.Results:All 81 patients completed surgica treatment successfully,No serious complications such as bone cement pulmonary embolism or paraplegia occurred during the operation.Both groups were followed up after the operation for 3-16 months,with an average of 6months.The VAS score and ODI in the study group and the control group were significantly improved at 3d afte the operation and at the final follow-up compared with those at baseline(allP<0.05).There were statisticall significant differences in the postoperative AVBH,MVBH and PVBH of the injured vertebrae between the stud group and control group(allP<0.05).There was statistically significant difference in the postoperative local Cobb angle of injured vertebrae between the two groups(P<0.05).The postoperative AVBH,MVBH,PVBH and loca Cobb angle of the injured vertebrae were significantly improved compared with those at baseline(allP<0.05)Conclusion:Both bilateral PKP and PVP may rapidly and effectively relieve the pain symptoms in patients with acute single-segment OVCF.Compared with bilateral PVP,bilateral PKP promotes the early recovery of the heigh of injured vertebrae,significantly improves the local Cobb angle of injured vertebrae,and effectively corrects th spine sagittal imbalance.