单侧和双侧入路经皮穿刺椎体后凸成形术治疗骨质疏松椎体压缩性骨折的对比研究

Comparative study of unilateral and bilateral percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fractures

目的对比研究单侧和双侧入路经皮穿刺椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松椎体压缩性骨折(osteoporotic vertebral compression fractures,OVCF)的临床效果。方法选取2018年6月至2020年10月在神木市人民医院接受PKP治疗的OVCF患者148例,根据手术入路不同分为单侧组(74例,单侧入路PKP)和双侧组(74例,双侧入路PKP)。评价两组的疼痛评分、病椎功能、并发症等指标。结果两组术后疼痛视觉模拟评分(visual analogue scale,VAS)及Oswestry功能障碍指数(Oswestry disability index,ODI)较术前明显下降(P<0.05),椎体前缘高度、中间高度及局部后凸Cobb角亦较术前显著改善(P<0.05),而两组间上述指标在各观测点均无明显差异(P>0.05);但单侧组手术时间、术中出血量、术中透视次数、骨水泥注射量、住院天数及1年内临近椎体再骨折率均显著低于双侧组(P<0.05),两组骨水泥渗漏率无明显差异(P>0.05)。结论单侧和双侧入路PKP在改善OVCF患者疼痛、恢复伤椎高度及功能方面的效果相当,但前者能大大缩短手术时间,减少术中出血、骨水泥用量及放射暴露,降低并发症及医疗费用。

Objective To compare the clinical effects of unilateral and bilateral percutaneous kyphoplasty(PKP)in the treatment of osteoporotic vertebral compression fracture(OVCF).Methods 148 patients with OVCF treated with PKP in Shenmu People's Hospital from June 2018 to October 2020 were selected and divided into unilateral group(74 cases,unilateral approach PKP)and bilateral group(74 cases,bilateral approach PKP)according to different surgical approaches.The pain score,vertebral function and complications were compared between the two groups.Results The visual analogue scale(VAS)and oswestry disability index(ODI)scores of the two groups were significantly lower than those before operation(P<0.05),and the anterior height,middle height and local kyphosis Cobb angle of the vertebral body were significantly improved than those before operation(P<0.05).There was no significant difference in the above indexes between the two groups at each observation point(P>0.05).However,the operation time,intraoperative bleeding,intraoperative fluoroscopy times,amount of bone cement,length of hospital stay and refracture rate of adjacent vertebral bodies in one year in the unilateral group were significantly lower than those in the bilateral group(P<0.05).There was no significant difference in bone cement leakage rate between the two groups(P>0.05).Conclusion Unilateral and bilateral PKP approaches are equally effective in improving pain,restoring injured vertebral height and function in patients with OVCF.However,the former can greatly shorten the operation time,reduce intraoperative bleeding,bone cement dosage and radiation exposure,and reduce complications and medical expenses.