单侧椎弓根外入路椎体成形术治疗骨质疏松性椎体压缩骨折的效果分析

Analysis of the Effect of Unilateral External Pedicle Approach Vertebroplasty in the Treatment of Osteoporotic Vertebral Compression Fractures

目的探讨单侧椎弓根外侧入路椎体成形术在治疗骨质疏松性椎体压缩骨折(OVCFs)中的应用价值。方法随机选取2018年1月—2020年1月该院收治的80例OVCFs患者,依据手术入路差异分成两组,其中40例采用单侧椎弓根外侧入路椎体成形术,纳入椎弓根外组;另外40例采用单侧椎弓根入路椎体成形术,纳入椎弓根组,对比两组围术期指标情况、骨水泥于椎体中心充盈分布率、疼痛程度评分、脊柱功能障碍指数ODI评分及并发症发生率。结果两组切口长度、术中失血量、骨水泥填充量和住院时长对比差异无统计学意义(P>0.05),椎弓根外组手术时长短于椎弓根组[(35.27±6.24)min vs(45.09±5.43)min],X线曝光次数少于椎弓根组[(19.32±3.20)次vs(28.01±3.21)次],差异有统计学意义(t=7.508、12.126,P<0.05)。椎弓根外组骨水泥于椎体中心充盈分布率为95.00%(38/40)高于椎弓根组的55.00%(22/40),差异有统计学意义(χ^(2)=17.067,P<0.05);两组术后24 h、1周和1个月疼痛评分较术前有所下降,但组间对比差异无统计学意义(P>0.05);术前两组ODI得分相比差异无统计学意义(P>0.05);术后24 h,两组ODI得分均降低,且椎弓根外组的降低幅度比椎弓根组更大,差异有统计学意义(P<0.05),术后1个月,两组ODI得分较术后24 h明显改善,但椎弓根外组的改善幅度更大,差异有统计学意义(P<0.05);两组并发症发生率对比,差异无统计学意义(P>0.05)。结论单侧椎弓根外入路与椎弓根入路椎体成形术治疗骨质疏松性椎体压缩骨折,均能达到理想的治疗效果,而单侧椎弓根外入路椎体成形术骨水泥填充均衡,脊柱功能明显改善,手术耗时短,且具有减少放射暴露次数的优势。

Objective To investigate the application value of unilateral lateral pedicle approach vertebroplasty in the treatment of osteoporotic vertebral compression fractures(OVCFs).Methods 80 patients with OVCFs treated in the hospital from January 2018 to January 2020 were randomly selected.They were divided into two groups according to the difference in surgical approach.Among them,40 cases underwent unilateral lateral pedicle approach vertebroplasty and were included in the extrapedicular group.Another 40 cases underwent unilateral pedicle approach vertebroplasty and were included in the pedicle group.The perioperative indicators,the filling distribution rate of bone cement in the center of the vertebral body,the pain severity score,the spinal dysfunction index ODI score and the incidence of complications were compared between the two groups.Results There was no significant difference in incision length,intraoperative blood loss,bone cement filling and length of hospitalization between the two groups(P>0.05).The operation time of the extrapedicle group was longer than that of the pedicle group[(35.27±6.24)min vs(45.09±5.43)min],and the number of X-ray exposure was less than that of the pedicle group[(19.32±3.20)times vs(28.01±3.21)times],the difference was statistically significant(t=7.508,4.203,P<0.05).The filling distribution rate of bone cement in the center of vertebral body in the extrapedicle group was 95.00%(38/40),and that in the pedicle group was 55.00%(22/40).The filling distribution rate of bone cement in the center of vertebral body in the extrapedicle group was higher than that in the pedicle group(χ^(2)=17.067,P<0.05);the pain scores of the two groups at 24 hours,1 week and 1 month after operation were lower than those before operation,but there was no significant difference between the two groups(P>0.05).There was no significant difference in ODI scores between the two groups before operation(P>0.05).At 24 h after operation,the ODI scores of the two groups decreased,and the reduction range of the extrapedicle group was greater than that of the pedicle group,the difference was statistically significant(P<0.05).At 1 month after operation,the ODI scores of the two groups were significantly improved compared with that of the 24 h after operation,but the improvement range of the extrapedicle group was greater,the difference was statistically significant(P<0.05);there was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion Unilateral external pedicle approach and pedicle approach vertebroplasty can achieve ideal therapeutic effects in the treatment of osteoporotic vertebral compression fractures.The unilateral external pedicle approach vertebroplasty has balanced bone cement filling,significantly improved spinal function,shorter operation time,and has the advantage of reducing the number of radiation exposures.