经横突-椎弓根外侧入路单侧穿刺双侧球囊扩张经皮椎体后凸成形术对骨质疏松性胸腰椎骨折患者创伤反应及骨水泥弥散情况的影响

Effects of unilateral puncture and bilateral balloon dilatation percutaneous kyphoplasty through transverse process-lateral pedicle approach on traumatic reaction and bone cement dispersion in patients with osteoporotic thoracolumbar fractures

目的探讨经横突-椎弓根外侧入路单侧穿刺双侧球囊扩张经皮椎体后凸成形术在骨质疏松性胸腰椎骨折患者中的应用效果。方法选取2019年6月至2022年6月收治的60例骨质疏松性胸腰椎骨折患者,根据术式差异将其分为对照组和观察组,各30例。对照组采用单侧经椎弓根入路经皮椎体后凸成形术治疗,观察组采用经横突-椎弓根外侧入路单侧穿刺双侧球囊扩张经皮椎体后凸成形术治疗。比较两组的治疗效果。结果观察组的手术时间、术后住院时间短于对照组,术中透视次数少于对照组,骨水泥弥散系数高于对照组(P<0.05)。手术前、后,两组的椎体前缘高度、Cobb角无显著差异(P>0.05)。手术后,观察组的肾上腺素(E)、C反应蛋白(CRP)以及皮质醇(Cor)水平均低于对照组(P<0.05)。手术前及手术后1、6个月,两组的腰椎功能障碍指数(ODI)评分无显著差异(P>0.05)。结论经横突-椎弓根外侧入路单侧穿刺双侧球囊扩张经皮椎体后凸成形术治疗骨质疏松性胸腰椎骨折能缩短手术时间,减少术中透视次数,提高骨水泥弥散效果,减轻创伤反应,加快术后恢复。

Objective To investigate the application effect of unilateral puncture and bilateral balloon dilatation percutaneous kyphoplasty through transverse process-lateral pedicle approach in patients with osteoporotic thoracolumbar fractures.Methods A total of 60 patients with osteoporotic thoracolumbar fractures admitted from June 2019 to June 2022 were selected and divided into control group and observation group according to the difference of operation methods,with 30 cases in each group.The control group was treated with percutaneous kyphoplasty via unilateral transpedicular approach,and the observation group was treated with unilateral puncture and bilateral balloon dilatation percutaneous kyphoplasty through transverse process-lateral pedicle approach.The therapeutic effects of the two groups were compared.Results The operation time and postoperative hospitalization time of the observation group were shorter than those of the control group,the number of intraoperative fluoroscopy was less than that of the control group,and the bone cement diffusion coefficient was higher than that of the control group(P<0.05).Before and after operation,there were no significant differences in the anterior vertebral height and Cobb angle between the two groups(P>0.05).After operation,the levels of epinephrine(E),C-reactive protein(CRP)and cortisol(Cor)in the observation group were lower than those in the control group(P<0.05).There was no significant difference in Oswestry Disability Index(ODI)score between the two groups before operation and at 1 and 6 months after operation(P>0.05).Conclusion The unilateral puncture and bilateral balloon dilatation percutaneous kyphoplasty through transverse process-lateral pedicle approach for osteoporotic thoracolumbar fractures can shorten the operation time,reduce the number of intraoperative fluoroscopy,improve the diffusion effect of bone cement,decline the traumatic reaction,and accelerate the postoperative recovery.