经横突上缘椎弓根外侧入路单侧PKP治疗伴椎弓根狭窄骨质疏松性腰椎骨折

Extrapedicular Unilateral Percutaneous Vertebroplasty Via the Upper Edge of the Transverse Process for Lumbar Osteoporotic Vertebral Compression Fractures With Pedicle Stenosis

目的 通过前瞻性研究比较经横突上缘椎弓根外侧入路单侧经皮椎体后凸成形术(percutaneous kyphoplasty, PKP)与传统经椎弓根入路单侧PKP治疗上腰椎Ⅱ型骨质疏松性椎体压缩骨折伴伤椎椎弓根狭窄患者的临床疗效。方法 对2020年12月至2021年12月收治的老年上腰椎Ⅱ型单椎体骨质疏松性椎体压缩骨折伴伤椎椎弓根狭窄的患者临床资料,按照随机数字表法分为A组(经横突上缘椎弓根外侧入路单侧PKP治疗,68例)和B组(采用传统椎弓根入路单侧PKP治疗,67例)。A组男性25例,女性43例;年龄60~89岁,平均年龄(70.40±6.95)岁;B组男性21例,女性46例;年龄60~85岁,平均年龄(73.02±8.51)岁。记录手术时间、透视次数、骨水泥注入量及骨水泥弥散效果,比较每组患者手术前后疼痛视觉模拟评分(visual analogue scale, VAS)、Oswestry功能障碍指数(Oswestry disability index, ODI)、伤椎椎体前缘高度(anterior height, AH)及伤椎后凸角(kyphosis angulation, KA)等。结果 所有患者均成功完成手术,41例因未规律随访或影像学资料不完整等原因失去随访,94例患者完成最终随访,随访时间11~14个月,平均(12.53±0.84)个月。B组有3例患者出现临近椎体压缩骨折。所有患者均未出现术区感染、肺栓塞等并发症。两组患者术后VAS、ODI评分较术前明显改善,两组间比较差异有统计学意义(P<0.05);两组患者术后1 d伤椎AH及KA较术前明显恢复,其中A组(22.12±0.58) mm、(14.32±0.40)°优于B组的(21.57±0.65) mm及(14.49±0.34)°,差异有统计学意义(P<0.05);A组骨水泥注入量及骨水泥对侧分布率分别为(6.45±0.35) mL、(58.10±4.11)%,优于B组的(5.29±0.48) mL、(25.82±3.92)%。结论 与传统经椎弓根入路相比,经横突上缘椎弓根外侧入路虽然在术后早期影像学方面差异不大,但其在兼顾手术安全性的同时,提高了骨水泥在椎体对侧弥散分布的程度,且在改善术后早期疼痛方面效果显著。

Objective To compare the clinical efficacy of extrapedicular unilateral percutaneous kyphoplasty(PKP)via the upper edge of the transverse process with that of traditional pedicle approach for the treatment of type II osteoporotic vertebral compression fracture with vertebral pedicle stenosis in the upper lumbar spine.Methods A prospective study was performed on the patients with II osteoporotic vertebral compression fractures of upper lumbar with pedicle stenosis treated from December 2020 to December 2021.According to random number table,the patients were divided into group A(treated with extrapedicular unilateral PKP via the upper edge of transverse process approach,68 cases)and group B(treated with unilateral PKP via transpedicle approach,67 cases).There were 25 males and 43 females in group A,aged from 60 to 89 years,with an average age of(70.40±6.95)years.In group B,there were 21 males and 46 females,aged from 60 to 85 years,with an average age of(73.02±8.51)years.The operation time,fluoroscopy frequency,bone cement injection volume,and bone cement dispersion were recorded.And the visual analogue scale(VAS),Oswestry disability index(ODI)score,anterior height(AH),and kyphotic angle(KA)of the injured vertebrae in each group were compared before and after surgery.Results All patients completed surgery successfully,41 patients lost follow-up due to irregular follow-up or incomplete imaging data,and 94 patients completed final follow-up for 11~14 months,with an average of(12.53±0.84)months.Three patients in group B developed compression fractures of the adjacent vertebrae.None of the patients had intraoperative infection,pulmonary embolism and other complications.VAS and ODI scores in 2 groups were significantly improved after surgery compared with before surgery,and the difference between 2 groups was statistically significant(P<0.05).The AH and KA of the injured vertebrae in both groups were significantly improved at 1 day after operation,and the AH and KA of the injured vertebrae in group A were(22.12±0.58)mm and(14.32±0.40)°,which were better than those in group B(21.57±0.65)mm and(14.49±0.34)°,the differences were statistically significant(P<0.05).The bone cement injection and the contralor distribution rate of bone cement in group A were(6.45±0.35)mL and(58.10±4.11)%,respectively,which were better than those in group B(5.29±0.48)mL and(25.82±3.92)%.Conclusion Compared with the traditional transpedicle approach,the extrapedicle approach via the upper edge of the transverse process has little difference in early postoperative imaging,however,it has significant effect on improving the degree of bone cement diffusion distribution on the contralateral side of the vertebral body and improving early postoperative pain while taking into account surgical safety.