单侧与双侧入路PKP对胸腰椎体压缩性骨折的影响

Effects of Unilateral Versus Bilateral PKP on Patients with Thoracolumbar Vertebral Compression Fractures

目的 分析单侧与双侧入路经皮椎体后凸成形术(PKP)对胸腰椎体压缩性骨折患者疼痛感、Cobb角恢复度、骨水泥渗漏率的影响。方法 经医院伦理学会批准选择医院2020年1月1日至2021年1月1日收诊的胸腰椎体压缩性骨折患者92例。采用计算机随机数字分组法将其分成单侧组和双侧组,例数均是46例。单侧组患者使用单侧入路PKP治疗,双侧组患者使用双侧入路PKP治疗。在治疗前后评定和比较两组患者前柱高度和疼痛、椎体压缩率和伤椎Cobb角及腰椎骨密度水平、Oswestry功能障碍指数(ODI)及血清瘦素水平、骨水泥渗漏和并发症。结果 术前两组患者前柱高度和疼痛评分差异比较无统计学意义(P>0.05)。单侧组患者术后6个月前柱高度(83.92±3.07)%大于双侧组(P<0.05),疼痛(1.01±0.28)分少于双侧组(P<0.05)。两组患者术前椎体压缩率、伤椎Cobb角、骨密度差异比较无统计学意义(P>0.05)。单侧组患者在术后6个月椎体压缩率(18.58±1.49)%和伤椎Cobb角(10.17±2.19)°均小于双侧组(P<0.05),骨密度(0.79±0.23)g/cm与双侧比较差异无统计学意义(P>0.05)。术前两组患者Oswestry功能障碍指数(ODI)、血清瘦素水平差异比较无统计学意义(P>0.05)。单侧组患者在术后6个月Oswestry功能障碍指数(ODI)(40.58±1.69)分低于双侧组(P<0.05),血清瘦素(8.26±1.78)ng/L与双侧组比较差异无统计学意义(P>0.05)。单侧组患者骨并发症率与双侧组比较,差异无统计学意义(P>0.05),水泥渗漏率低于双侧组(P<0.05)。结论 相较双侧入路而言,单侧入路PKP能显著减少胸腰椎体压缩性骨折患者疼痛感,促使Cobb角恢复,减少骨水泥渗漏,推荐使用。

Objective To analyze the effects of unilateral versus bilateral percutaneous kyphoplasty(PKP)on pain perception,Cobb angle recovery and bone cement leakage rate in patients with thoracolumbar vertebral compression fractures.Methods With the approval of the hospital ethical committee,92 patients with thoracolumbar vertebral compression fractures admitted to the hospital from January 1,2020 to January 1,2021 were selected,and divided into two groups by computer,each with 46 cases.Unilateral group received PKP surgery via unilateral approach,while bilateral group received PKP surgery via bilateral approach.Then the anterior height of the injured vertebral body,pain degree,vertebral compression rate,Cobb angle,lumbar spine bone mineral density,Oswestry disability index(ODI)score,serum leptin level,bone cement leakage rate and complications were assessed at the baseline and after treatment.Results The scores of anterior height of the injured vertebral body and pain degree yielded no statistical difference between two groups before surgery(P>0.05).At postoperative 6 months,unilateral group had higher recovery rate of anterior height of the injured vertebral body(83.92±3.07)%and lower pain score(1.01±0.28)than those of bilateral group,with statistical difference(P<0.05).The vertebral compression rate,Cobb angle and bone mineral density demonstrated no statistical difference between two groups before treatment(P>0.05),while the vertebral compression rate and Cobb angle were(18.58±1.49)%and(10.17±2.19)°in unilateral group at postoperative 6 months,and were obviously lower than those of bilateral group(P<0.05).The bone mineral density was(0.79±0.23)g/cm in unilateral group at postoperative 6 months,which had no statistical difference with that of bilateral group(P>0.05).ODI score and serum leptin level showed no statistical difference between two groups before surgery(P>0.05),and the score was(40.58±1.69)in unilateral group at postoperative 6 months,which was obviously lower than that of bilateral group(P<0.05).Serum leptin level was(8.26±1.78)ng/L in unilateral group at postoperative 6 months,and had no statistical difference with that of bilateral group(P>0.05).No statistical difference was found in the complication rate between two groups(P>0.05),while the bone cement leakage rate in unilateral group was lower than that of bilateral group(P<0.05).Conclusion Compared with bilateral approach,PKP surgery via unilateral approach can effectively alleviate the pain,promote the recovery of Cobb angle and reduce the cement leakage rate in patients with thoracolumbar vertebral compression fractures,which is worthy of recommendation.