单侧与双侧入路经皮椎体后凸成形术治疗老年骨质疏松性椎体压缩骨折患者的效果比较

Comparison of effects of unilateral and bilateral percutaneous kyphoplasty in treatment of elderly patients with osteoporotic vertebral compression fractures

目的:比较单侧与双侧入路经皮椎体后凸成形术(PKP)治疗老年骨质疏松性椎体压缩骨折(OVCF)患者的效果。方法:回顾性分析2019年1月至2021年3月该院收治的86例老年OVCF患者的临床资料,将43例行单侧入路PKP的OVCF患者设为单侧组,43例行双侧入路PKP的OVCF患者设为双侧组。比较两组手术相关指标(手术时间、X线照射时间、每椎体骨水泥用量、术中X线透视次数)水平,术前,术后1 d,术后3、6个月Cobb角,伤椎前缘高度,视觉模拟评分法(VAS)评分,Oswestry功能障碍指数(ODI)评分,以及术后并发症生率。结果:单侧组手术时间、X线照射时间均短于双侧组,每个椎体骨水泥用量、术中X线透视次数均少于双侧组,差异有统计学意义(P<0.05);术后1 d及术后3、6个月,两组Cobb角均低于术前,伤椎前缘高度均高于术前,差异有统计学意义(P<0.05),但组间Cobb角和伤椎前缘高度比较,差异无统计学意义(P>0.05);两组VAS、ODI评分均低于术前,差异有统计学意义(P<0.05),但组间比较,差异无统计学意义(P>0.05);两组并发症发生率比较,差异无统计学意义(P>0.05)。结论:单侧与双侧入路PKP治疗老年OVCF患者效果和安全性相当,但单侧入路PKP可缩短手术时间、X线照射时间,减少每个椎体骨水泥用量、术中X线透视次数。

Objective: To compare effects of unilateral and bilateral percutaneous kyphoplasty(PKP) in treatment of elderly patients with osteoporotic vertebral compression fractures(OVCF). Methods: The clinical data of 86 elderly patients with OVCF admitted to the hospital from January 2019 to March 2021 were retrospectively analyzed. 43 patients with OVCF who underwent unilateral PKP were set as unilateral group, and 43 patients with OVCF who underwent bilateral PKP were set as bilateral group. The operation related index levels(operation time, X-ray irradiation time, bone cement dosage per vertebral body, number of intraoperative X-ray fluoroscopy), the Cobb angles, the anterior vertebral heights, the visual analogue scale(VAS) scores, the Oswestry disability index(ODI) scores before and 1 day as well as 3 and 6 months after the surgery, and the incidence of postoperative complications were compared between the two groups. Results: The operation time and the X-ray irradiation time of the unilateral group were shorter than those of the control group, the amount of bone cement per vertebral body and the number of intraoperative X-ray fluoroscopy were less than those of the bilateral group, and the differences were statistically significant(P<0.05). 1 day as well as 3 and 6 months after the surgery, the Cobb angles of the two groups were lower than those before the surgery, and the anterior edge height of the injured vertebrae was higher than that before the surgery, and the differences were statistically significant(P<0.05);however, there were no significant differences in the Cobb angle and the anterior vertebral height between the two groups(P>0.05). 1 day as well as 3 and 6 months after the surgery, the VAS and ODI scores of the two groups were lower than those before the surgery, and the differences were statistically significant(P<0.05);however, there were no significant differences in the VAS and ODI scores between the two groups(P>0.05). There was no significant difference in the incidence of complications between the two groups(P>0.05). Conclusions: The efficacy and safety of unilateral and bilateral PKP in the treatment of the elderly patients with OVCF are comparable, but the unilateral PKP can shorten the operation time and the X-ray irradiation time, and reduce the amount of bone cement per vertebral body and the number of intraoperative X-ray fluoroscopy.