不同体位经皮椎体后凸成形术治疗合并慢性肺病的骨质疏松性椎体压缩性骨折的比较研究

A comparative study of different positions of percutaneous kyphoplasty for patients with osteoporotic vertebral compression fractures complicated with chronic lung disease

目的探讨俯卧位和侧卧位经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗合并慢性肺病的骨质疏松性椎体压缩性骨折(osteoporotic vertebral compression fractures,OVCF)的疗效和安全性。方法回顾性分析台州市立医院2017年10月至2021年10月50例患者的临床资料,根据体位不同分为对照组(俯卧位)25例和观察组(侧卧位)25例。观察并随访12个月记录两组患者血氧饱和度变化、手术时间、疼痛视觉模拟(visual analogue scale,VAS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI),伤椎的Cobb’s角、椎体前缘压缩比值变化及并发症。结果除对照组有2例患者无法耐受外,其余48例患者均顺利完成手术,观察组较对照组术中低血氧饱和度发生率更低,手术时间更短,两组比较差异有统计学意义(P<0.05),两组骨水泥渗漏发生率差异无统计学意义。术后及末次随访时VAS评分、ODI评分、Cobb’s角、椎体前缘压缩比值两组比较差异无统计学意义(P>0.05)。结论两种体位PKP治疗合并慢性肺病的OVCF患者都获得了较好的疗效。但与俯卧位组相比,侧卧位组手术时间更短,对患者术中血氧饱和度的影响更小,有利于提高患者手术安全性和耐受性。

Objective To observe and compare the prone and lateral position on percutaneous kyphoplasty combined chronic lung disease percutaneous kyphoplasty(PKP)treatment of senile osteoporotic vertebral compression fractures(OVCF).Methods 50 patients with osteoporotic vertebral compression fracture who received PKP treatment from October 2017 to October 2021 were retrospectively analyzed,including 25 patients who received prone percutaneous kyphoplasty(control group)and 25 patients who received lateral percutaneous kyphoplasty(observation group).Changes in blood oxygen saturation,operation time,visual analogue scale(VAS)score for pain,Oswestry disability index(ODI)were recorded after 12 months of follow-up.Changes of Cobb’s angle and anterior vertebral compression ratio of injured vertebra and complications.Results All 48 patients were successfully operated except 2 patients in the control group who could not tolerate the operation.The incidence of intraoperative hypooxygen saturation in the control group was higher than that in the observation group,and the operation time was longer than that in the observation group,and the difference was statistically significant(P<0.05),there was no significant difference in the incidence of bone cement leakage between the two groups.There were no significant differences in VAS score,ODI score,Cobb’s Angle and anterior vertebral compression ratio between the two groups after surgery and the last follow-up(P>0.05).Conclusion Two kinds of percutaneous kyphoplasty for patients with osteoporotic vertebral compression fracture complicated with chronic lung disease have achieved good results.However,compared with prone position,lateral decubitus has shorter operation time and less influence on intraoperative blood oxygen saturation,which is beneficial to improve surgical safety and tolerance of patients.