两种入路经皮椎体后凸成形术治疗中老年胸椎骨质疏松性椎体压缩骨折的对比研究

Comparison of two approaches of percutaneous kyphoplasty in treatment of osteoporotic vertebral compression fractures in middle and old age

目的 比较中老年骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures, OVCF)患者采用单侧及双侧入路经皮椎体后凸成形术(percutaneous kyphoplasty, PKP)的临床效果。方法 选取2021年12月—2022年12月郑州大学第一附属医院骨科行PKP手术的OVCF患者90例,随机分为研究组和对照组各45例,对照组采用双侧入路,研究组采用单侧入路,比较两组手术指标、术后视觉模拟疼痛(VAS)、Oswestry功能障碍指数(ODI)评分、椎体前缘高度以及并发症发生情况。结果 研究组手术时间、术中出血量、透视次数及骨水泥注入量为(41.38±9.21)min、(6.82±1.64)mL、(15.26±2.75)次、(4.41±0.58)mL,均少于对照组(P<0.05);术前两组VAS、ODI评分以及伤椎高度比较无统计学意义(P>0.05),术后VAS、ODI评分均降低,椎体前缘高度均升高,与术前比较差异显著(P<0.05),但研究组术后VAS、ODI评分以及伤椎高度为(2.08±0.21)分、(23.49±5.87)分及(72.48±19.25)°,与对照组比较无统计学意义(P>0.05);术后,研究组骨水泥渗漏、神经损伤以及肺栓塞等并发症发生率为6.67%,与对照组的8.89%比较差异显著(P>0.05)。结论 单、双侧两种入路PKP治疗OVCF效果与安全性相当,但单侧入路的手术时间更短,术中出血量、透视次数以及骨水泥注入量更少,更具推广价值。

Objective To compare the clinical effects of two approaches of percutaneous kyphoplasty(PKP) for middle-aged and elderly patients with osteoporotic vertebral compression fracture(OVCF).Methods From December 2021 to December 2022, 90 patients with OVCF who received PKP surgery in the orthopedics department of our hospital were selected to conduct a grouping study. The grouping method was odd-even number method, the control group(n=45) was operated with bilateral approach, and the research group(n=45) was operated with unilateral approach. Surgical parameters, postoperative visual analogue pain(VAS), Oswestry Disability Index(ODI) score, vertebral anterior margin height, and incidence of complications were compared between the two groups.Results The operative time, intraoperative blood loss, fluoroscopy times and bone cement injection volume of the study group were(41.38±9.21) min,(6.82±1.64) mL,(15.26±2.75) times and(4.41±0.58) mL, which were all lower than those of the control group(P<0.05). There was no statistical significance in VAS, ODI scores and the height of injured vertebra between the two groups before surgery(P>0.05). After surgery, VAS and ODI scores were decreased, and the height of anterior vertebral margin was increased, which was significantly different from that before surgery(P<0.05). However, VAS, ODI scores and injured vertebral height of the study group were(2.08±0.21) points,(23.49±5.87) points and(72.48±19.25) °, which had no statistical significance compared with the control group(P>0.05). After operation, the incidence of bone cement leakage, nerve injury and pulmonary embolism in the study group was 6.67%, which was significantly different from 8.89% in the control group(P>0.05).Conclusion The efficacy and safety of single and bilateral PKP approaches in the treatment of OVCF are comparable, but the unilateral approach has shorter operative time, less intraoperative blood loss, fluoroscopy times and bone cement injection amount, and is more valuable for promotion.