单侧与双侧穿刺经皮椎体成形术治疗老年骨质疏松性骨折患者的效果比较

Comparison of effects of unilateral and bilateral percutaneous vertebroplasty in treatment of elderly patients with osteoporotic fractures

目的:比较单侧与双侧穿刺经皮椎体成形术(PVP)治疗老年骨质疏松性骨折患者的效果。方法:选取2020年8月至2022年8月该院收治的110例老年骨质疏松性骨折患者进行前瞻性研究,按照随机数字表法将其分为单侧组和双侧组各55例。两组均行PVP术治疗,单侧组实施单侧椎弓根入路经皮穿刺,双侧组实施双侧椎弓根入路经皮穿刺。比较两组围术期指标(手术时间、骨水泥用量、透视次数、住院时间)水平,手术前后伤椎前缘高度和Cobb角,腰椎功能[日本骨科协会评估治疗分数(JOA)]评分、疼痛程度[视觉模拟评分法(VAS)]评分及并发症发生率。结果:单侧组手术时间短于双侧组,骨水泥用量和透视次数均少于双侧组,差异有统计学意义(P<0.05);两组住院时间比较,差异无统计学意义(P>0.05);术后6个月,两组伤椎前缘高度均高于术前,Cobb角均低于术前,但组间比较,差异均无统计学意义(P>0.05);两组JOA评分均高于术前,VAS评分均低于术前,但组间比较,差异均无统计学意义(P>0.05);两组并发症发生率比较,差异无统计学意义(P>0.05)。结论:单侧PVP治疗老年骨质疏松性骨折患者可减少骨水泥用量和透视次数,以及缩短手术时间的效果优于双侧PVP治疗,两种入路术式的其他手术指标水平相当。

Objective:To compare effects of unilateral and bilateral percutaneous vertebroplasty(PVP)in treatment of elderly patients with osteoporotic fractures.Methods:A prospective study was conducted on 110 elderly patients with osteoporotic fractures admitted to the hospital from August 2020 to August 2022.According to the random number table method,they were divided into unilateral group and bilateral group,55 cases in each group.Both groups were treated with PVP.The unilateral group was treated with percutaneous puncture through the unilateral pedicle approach,while the bilateral group was treated with percutaneous puncture through the bilateral pedicle.The perioperative indexes(operation time,bone cement dosage,fluoroscopy time,hospitalization time),the injured vertebral anterior edge height and the Cobb angle before and after the surgery,the lumbar function[Japanese Orthopaedic Association(JOA)score],the pain degree[visual analogue scale(VAS)]score,and the incidence of complications were compared between the two groups.Results:The operation time of the unilateral group was shorter than that of the bilateral group,the bone cement dosage and the fluoroscopy time were less than those of the bilateral group,and the differences were statistically significant(P<0.05).6 months after the surgery,the injured vertebral anterior edge height levels in both groups were higher than those before the surgery,and the Cobb angle levels were lower than those before the surgery;however,there was no statistically significant difference between the groups(P>0.05).The JOA scores of the two groups were higher than those before the surgery,and the VAS scores were lower than those before the surgery,but there were no significant differences between the two groups(P>0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusions:Unilateral PVP in the treatment of the elderly patients with osteoporotic fractures can reduce the bone cement dosage and the fluoroscopy time and shorten the operation time.It is superior to bilateral PVP.The other surgical indexes of the two approaches are comparable.