经皮弯角椎体成形术与单侧经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折的疗效比较

Comparison of curative effects between percutaneous curved vertebroplasty and unilateral percutaneous kyphoplasty in the treatment of osteoporotic thoracolumbar compression fracture

目的比较经皮弯角椎体成形术(PCVP)与单侧经皮椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩骨折(OVCF)的临床效果。方法采用回顾性队列研究分析2019年9月至2020年9月天津医院收治的104例单发椎体OVCF患者的临床资料,其中男21例,女83例;年龄50~91岁[(70.3±7.7)岁]。骨折AO分型:A1型65例,A2型39例。患者接受PCVP或单侧PKP手术治疗,其中51例行PCVP(PCVP组),53例行单侧PKP(单侧PKP组)。比较两组手术时间、骨水泥注射量、术中透视次数、骨水泥有效弥散倍数、骨水泥分布优秀率。术前,术后24 h、3个月、6个月采用视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)和Beck指数(测量至术后3个月)评价两组治疗效果。比较两组骨水泥渗漏率、邻近椎体再骨折率等术后并发症情况。结果患者均获随访6~8个月[(6.4±0.7)个月]。PCVP组手术时间为(12.15±1.63)min,骨水泥注射量为(2.13±0.28)ml,术中透视次数为(24.74±1.71)次,均短于或少于单侧PKP组的(22.09±1.62)min、(5.30±0.52)ml、(30.09±1.86)次(P均<0.01)。PCVP组骨水泥有效弥散倍数为(1.42±0.04)倍,大于单侧PKP组的(1.18±0.02)倍(P<0.01);骨水泥分布优秀率为94%,高于单侧PKP组的70%(P<0.01)。术前和术后24 h、3个月两组VAS、ODI、Beck指数差异无统计学意义(P均>0.05);术后6个月PCVP组VAS为(1.20±0.49)分,ODI为16.52±5.22,较单侧PKP组的(1.49±0.58)分、20.16±5.16更低(P均<0.01)。两组术后24 h、3个月、6个月的VAS、ODI较术前有明显改善(P均<0.05);两组术后24 h、3个月Beck指数较术前改善(P均<0.05),单侧PKP组术后3个月Beck指数为0.75±0.07,较术后24 h的0.79±0.07明显下降(P<0.05),而PCVP组无明显变化(P>0.05)。PCVP组骨水泥渗漏率为16%(8/51),低于单侧PKP组的47%(25/53)(P<0.01)。两组随访期间邻近椎体再骨折发生率差异无统计学意义(P>0.05)。结论对于OVCF,相较单侧PKP,PCVP具有手术时间短、骨水泥注射量小、术中透视次数少、椎体内骨水泥弥散效果更好、疼痛减轻、功能改善并更好地维持伤椎高度及骨水泥渗漏发生率低等优势。

Objective To compare the clinical effects of percutaneous curved vertebroplasty(PCVP)and unilateral percutaneous kyphoplasty(PKP)in the treatment of osteoporotic vertebral compression fracture(OVCF).Methods A retrospective cohort study was used to analyze the clinical data of 104 patients with single vertebral OVCF treated in Tianjin Hospital from September 2019 to September 2020,including 21 males and 83 females;aged 50-91 years[(70.3±7.7)years].AO classification of the fracture was type A1 in 65 patients and type A2 in 39.The patients received PCVP(PCVP group,n=51)or unilateral PKP surgery(unilateral PKP group,n=53).The operation time,bone cement injection volume,intraoperative fluoroscopy frequency,effective dispersion times of bone cement and excellent rate of bone cement distribution were compared between the two groups.In evaluation of the therapeutic effects of the two groups,visual analogue scale(VAS)and Oswestry dysfunction index(ODI)were measured preoperatively and at postoperative 24 hours,3 months and 6 months;Beck index was measured preoperatively and at postoperative 24 hours and 3 months.The rate of bone cement leakage and rate of refracture of adjacent vertebral bodies were compared between the two groups.Results All patients were followed up for 6-8 months[(6.4±0.7)months].The operation time,bone cement injection volume and intraoperative fluoroscopy frequency in PCVP group was(12.15±1.63)minutes,(2.13±0.28)ml and(24.74±1.71)times,shorter or less than(22.09±1.62)minutes,(5.30±0.52)ml and(30.09±1.86)times in unilateral PKP group(all P<0.01).The effective dispersion times of bone cement in PCVP group was(1.42±0.04)times,higher than(1.18±0.02)times in unilateral PKP group(P<0.01).The excellent rate of bone cement distribution in PCVP group was 94%,higher than 70%in unilateral PKP group(P<0.01).There were no significant differences in VAS,ODI and Beck index between the two groups before operation and at 24 hours and 3 months after operation(all P>0.05).VAS and ODI in PCVP group were(1.20±0.49)points and 16.52±5.22 at 6 months after operation,lower than(1.49±0.58)points and 20.16±5.16 in unilateral PKP group(all P<0.01).VAS and ODI in the two groups were significantly improved at 24 hours,3 months and 6 months after operation when compared with those before operation(all P<0.05).Beck index in the two groups detected at 24 hours and 3 months after operation was improved from that before operation(all P<0.05).Unilateral PKP group showed Beck index was 0.75±0.07 at 3 months after operation,significantly lower than 0.79±0.07 at 24 hours after operation(P<0.05),but there was no significant change in PCVP group(P>0.05).The leakage rate of bone cement in PCVP group was 16%(8/51),lower than 47%(25/53)in unilateral PKP group(P<0.01).There was no significant difference in the incidence of refracture of adjacent vertebral bodies between the two groups during follow-up(P>0.05).Conclusion For OVCF,PCVP is superior to unilateral PKP in terms of operation time,amount of bone cement injection,intraoperative fluoroscopy frequency,dispersion effect of bone cement in vertebral body,pain,function improvement,maintenance of injured vertebral height and incidence of bone cement leakage.