经单侧横突-椎弓根入路经皮椎体成形术治疗老年腰椎骨质疏松性椎体压缩骨折的疗效观察

Efficacy of PVP in the treatment of lumbar OVCF in elderly patients with unilateral transverse process-pedicle approach

目的探讨经单侧横突-椎弓根(unilateral transverse process-pedicular,UTPP)入路经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗老年骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)的临床特点。方法收集2020年1月至2022年1月于邯郸市中心医院骨五科行经单侧椎弓根(unilateral transpedicular,UTP)及UTPP入路PVP治疗老年腰椎OVCF患者共133例。记录两组的研究术后VAS评分(visual analogue scale,VAS)、ODI评分(Oswestry disability index,ODI)、手术时间、骨水泥注入量、骨水泥分布特点、骨水泥分布优秀率、骨水泥渗漏率、椎体前缘高度和Cobb角等指标。结果完整随访患者124例至术后12个月。两组患者的术后1 d、6个月、12个月的VAS评分、ODI评分均较术前降低,与术前比较差异有统计学意义(P<0.05)。两组患者手术时间比较,差异无统计学意义(P>0.05);UTPP组骨水泥注入量大于UTP组,骨水泥分布优秀率高于UTP组,骨水泥渗漏率低于UTP组,差异有统计学意义(P<0.05)。两组术后1 d的椎体前缘高度和Cobb角比较,差异无统计学意义(P>0.05)。结论经单侧横突-椎弓根入路较经椎弓根入路PVP骨水泥弥散充分,骨水泥渗漏率低,止疼效果好,可实现患者早期下地、提高患者生活质量。

Objective To investigate the clinical characteristics of percutaneous vertebroplasty(PVP)in the treatment of osteoporotic vertebral compression fracture(OVCF)in elderly patients using a unilateral transverse process-pedicle approach.Methods The cases of PVP via unilateral transpedicular(UTP)and unilateral transverse process-pedicular(UTPP)approach in the treatment of lumbar OVCF in the elderly in the department of the fifth orthopedics of Handan Central Hospital from January 2020 to January 2022 were collected,totally 133 patients.The postoperative visual analogue scale(VAS),Oswestry disability index(ODI),operation time,bone cement injection amount,bone cement distribution characteristics,excellent distribution rate of bone cement,bone cement leakage rate,anterior edge height of vertebral body and Cobb angle were comparatively studied.Results A total of 124 patients were completely followed for 12 months.The VAS and ODI of the two groups at 1 d,6 months and 12 months after surgery were lower than those before surgery(P<0.05).There was no statistically significant difference between the two groups in operation time(P>0.05).The injection amount of bone cement in the UTPP group was significantly higher than that in the UTP group,the excellent distribution rate of bone cement in the UTPP group was higher than that in the UTP group,the leakage rate of bone cement in the UTPP group was lower than that in the UTP group,and the difference was statistically significant(P<0.05).There were no statistically significant differences between the two groups in anterior edge height of the vertebral body and the Cobb angle(P>0.05).Conclusion Compared with the UTPP approach,PVP cement diffuses more adequately than UTP approach,has a low leakage rate of bone cement,and has a good analgesic effect,which can realize early mobility and improve the quality of life of patients.