弯角椎体成形术对老年骨质疏松性椎体压缩骨折患者功能恢复及Cobb′s角的影响

Effects of percutaneous curved vertebroplasty on functional recovery and Cobb′s angle in elderly patients with osteoporotic vertebral compression fracture

目的 探讨弯角椎体成形术(PVCP)用于老年骨质疏松性椎体压缩骨折(OVCF)患者对功能恢复及Cobb′s角的影响。方法 回顾性选取2020年1月1日至2021年12月30日大同市第二人民医院收治的98例老年OVCF患者,根据其手术方式将行PVCP术的36例患者设为PVCP组,将经单侧入路经皮椎体成形术(PVP)的30例患者设为单侧组,将经双侧入路PVP术的32例患者设为双侧组。收集各组患者围手术期指标(手术时间、术中X线曝光次、每椎体骨水泥用量)、术前及术后不同时间点功能恢复相关指标[Oswestry功能障碍指数(ODI)、Cobb′s角,伤椎前缘椎体高度情况、视觉模拟评分法(VAS)评分]变化情况。观察各组患者骨水水泥分布情况,记录各组患者术后并发症发生情况。结果 3组间手术时间、术中X线曝光次数和每椎体骨水泥用量比较,差异均有统计学意义(P<0.05)。其中PVCP组与单侧组比较:手术时间和术中X线曝光次数比较,差异无统计学意义(P>0.05);PVCP组每椎体骨水泥用量多于单侧组(P<0.05)。PVCP组与双侧组比较:PVCP组手术时间、术中X线曝光次和每椎体骨水泥用量均低于双侧组(P<0.05)。3组间骨水泥注入时间比较,差异无统计学意义(P>0.05);3组间各时间点ODI评分比较,差异无统计学意义(P>0.05);术后3个月及6个月,PVCP组Cobb′s角低于单侧组(P<0.05),与双侧组比较,差异无统计学意义(P>0.05)。3组间各时间点VAS评分比较,差异无统计学意义(P<0.05);术后24 h、3个月和6个月,PVCP组伤椎前缘椎体高度高于单侧组(P<0.05),和双侧组比较,差异无统计学意义(P>0.05)。PVCP组骨水泥分布合理率与双侧组比较,差异无统计学意义(P>0.05),PVCP组和双侧组骨水泥分布合理率均高于单侧组(P<0.05)。PVCP组的骨水泥渗漏或移位率低于单侧组(P<0.05)。结论 PVCP术在维持较短的手术时间和较少的X线曝光次数的同时保证骨水泥合理分布,改善术后椎体功能和Cobb′s角。

Objective To explore the effects of percutaneous curved vertebroplasty(PVCP) on functional recovery and Cobb′s angle in elderly patients with osteoporotic vertebral compression fracture(OVCF).Methods A total of 98 elderly patients with OVCF admitted to the hospital were retrospectively enrolled between January 1,2020 and December 30,2021.According to different surgical methods, 36 cases undergoing PVCP were enrolled as PVCP group, 30 cases undergoing percutaneous vertebroplasty(PVP) through unilateral approach were enrolled as unilateral group, and 32 cases undergoing PVP through bilateral approach were enrolled as bilateral group.The perioperative indexes(operation time, exposure times of intraoperative X-ray, usage volume of bone cement per vertebra) and functional recovery-related indexes[Oswestry disability index(ODI),Cobb′s angle, anterior edge height of injured vertebra, visual analogue scale(VAS)]before and after surgery in different groups were collected.The distribution of bone cement in each group was observed.The occurrence of postoperative complications in each group was recorded.Results There were significant differences in operation time, exposure times of intraoperative X-ray and usage volume of bone cement per vertebra among the three groups(P<0.05).There was no difference in operation time or exposure times of intraoperative X-ray between PVCP group and unilateral group(P>0.05).The usage volume of bone cement per vertebra in PVCP group was more than that in unilateral group(P<0.05).The operation time, exposure times of intraoperative X-ray and usage volume of bone cement per vertebra in PVCP group were lower than those in bilateral group(P<0.05).There was no significant difference in injection time of bone cement among the three groups(P>0.05).There was no difference in ODI scores among the three groups(P>0.05).At 3 and 6 months after surgery, Cobb′s angle in PVCP group was lower than that in unilateral group(P<0.05),but there was no difference between PVCP group and bilateral group(P>0.05).There was no difference in VAS scores among the three groups(P<0.05).At 24 h, 3 months and 6 months after surgery, anterior edge height of injured vertebra in PVCP group was higher than that in unilateral group(P<0.05),but there was no difference between PVCP group and bilateral group(P>0.05).There was no difference in reasonable rate of bone cement distribution between PVCP group and bilateral group(P>0.05).The reasonable rate of bone cement distribution in PVCP group and bilateral group was higher than that in unilateral group(P<0.05).The incidence of bone cement leakage or displacement in PVCP group was lower than that in unilateral group(P<0.05).Conclusions PVCP can ensure reasonable distribution of bone cement while maintaining shorter operation time and fewer X-ray exposure times, which can improve postoperative vertebral function and Cobb′s angle.