经单侧或双侧椎弓根途径行椎体后凸成形术治疗老年骨质疏松性椎体压缩骨折对比研究

A Comparative Study of Posterior Kinkoplasty via Unilateral or Bilateral Pedicle Approaches for the Treatment of Osteoporotic Vertebral Compression Fractures in the Elderly

目的探究与分析经单侧或双侧椎弓根途径行椎体后凸成形术(Posterior Kinkoplasty,PKP)治疗老年骨质疏松性椎体压缩骨折的效果。方法随机选取2019年4月—2022年1月福州市第一医院收治的老年骨质疏松性椎体压缩骨折患者90例,按照不同手术治疗方法分为单侧组(n=48)及双侧组(n=42),单侧组给予单侧椎弓根途径行椎体后凸成形术治疗,双侧组给予双侧椎弓根途径行椎体后凸成形术治疗。对比两组患者的围术期指标、手术治疗前后的椎体前缘高度压缩率、椎体前缘高度、椎体中间高度、伤椎Cobb角、视觉模拟评分(VAS)及ODI指数,同时观察两组患者并发症。结果单侧组手术时间、术中透视时间、骨水泥注入量、住院时间比双侧组少,差异有统计学意义(P<0.05)。治疗后,两组患者椎体前缘高度压缩率、伤椎Cobb角小于治疗前,椎体前缘高度、椎体中间高度高于治疗前,差异有统计学意义(P<0.05)。治疗后,两组患者VAS评分、ODI指数低于治疗前,差异有统计学意义(P<0.05);治疗后,两组VAS评分、ODI指数相比,差异无统计学意义(P>0.05)。治疗后,两组患者均进行了为期3个月的随访,切口均为一期愈合,且经过治疗后尚未出现静脉血栓、坠积性肺炎以及压力性损伤等并发症。结论经单侧或双侧PKP治疗老年骨质疏松性椎体压缩骨折均会取得较好的效果,但单侧与双侧相比能够获得更好的围术期指标,预后综合表现较好。

Objective To investigate and analyze the effect of Posterior Kinkoplasty(PKP)on compression fractures of senile osteoporotic vertebra by unilateral or bilateral pedicle approach.Methods Ninety elderly patients with osteoporotic vertebral compression fracture admitted to Fuzhou First Hospital from April 2019 to January 2022 were randomly selected and divided into unilateral group(n=48)and bilateral group(n=42)according to different surgical treatment methods.The unilateral group was treated with kyphoplasty through unilateral pedicle approach.In the bilateral group,kyphoplasty was performed through bilateral pedicle approach.The perioperative indexes,anterior vertebral edge height compression ratio,anterior vertebral edge height,middle vertebral height,Cobb Angle of injured vertebral body,visual analog score(VAS)and ODI index of the two groups were compared before and after surgical treatment.The complications of the two groups were observed at the same time.Results The operation time,intraoperative fluoroscopy time,bone cement injection amount and hospital stay in unilateral group were less than those in bilateral DOI:10.16662/j.cnki.1674-0742.2023.11.108 group,and the difference was statistically significant(P<0.05).After treatment,the compression ratio of vertebral anterior margin and Cobb Angle of injured vertebra were lower than before treatment,while the height of vertebral anterior margin and middle height of vertebral body were higher than before treatment,and the difference was statistically significant(P<0.05).After treatment,VAS score and ODI index of two groups were lower than before treatment,and the difference was statistically significant(P<0.05);after treatment,there was no statistically significant difference in VAS score and ODI index between the two groups(P>0.05).After treatment,patients in both groups were followed up for 3 months.The incisions were healed in one stage,and no complications such as venous thrombosis,sedimentation pneumonia and press injury were found after treatment.Conclusion Both unilateral and bilateral PKP in the treatment of osteoporotic vertebral compression fractures in the elderly can achieve good results,but unilateral and bilateral PKP can obtain better perioperative indexes,and the overall prognosis is better.