单侧经皮椎体后凸成形术结合对侧脊神经后内侧支阻滞术治疗老年腰椎骨质疏松性椎体压缩骨折的疗效

Efficacy of unilateral percutaneous kyphoplasty combined with posterior medial branch block of the contralateral spinal nerve in the treatment of lumbar osteoporotic vertebral compression fracture in the elderly

目的比较单侧经皮椎体后凸成形术(PKP)与单侧PKP结合对侧脊神经后内侧支阻滞术治疗老年腰椎骨质疏松性椎体压缩骨折(OVCF)的疗效。方法采用回顾性队列研究分析2019年1月至2023年1月西安交通大学医学院附属西安市中心医院收治的161例新发老年腰椎OVCF患者的临床资料,其中男58例,女103例;年龄61~88岁[(72.9±6.3)岁]。患者均为急性症状性骨质疏松性胸腰椎骨折分型系统(ASOTLF)Ⅱ型椎体压缩骨折。78例行单侧PKP治疗(PKP组),83例行单侧PKP结合对侧脊神经后内侧支阻滞术治疗(PKP结合对侧阻滞组)。比较两组手术时间、术中出血量、住院时间;术前,术后1 d、1周、1个月、3个月及末次随访时伤椎Beck指数、腰椎前凸Cobb角、罗兰莫里斯残疾(RMD)评分、视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)。比较两组骨水泥渗漏等并发症发生率。结果患者均获随访6~8个月[(6.7±0.6)个月]。两组手术时间、术中出血量、住院时间差异均无统计学意义(P>0.05)。术前,术后1 d、1周、1个月、3个月及末次随访时,两组伤椎Beck指数、腰椎前凸Cobb角差异均无统计学意义(P>0.05)。术前两组伤椎RMD评分、VAS、ODI差异均无统计学意义(P>0.05)。术后1 d、1周、1个月、3个月及末次随访时PKP结合对侧阻滞组RMD评分分别为(11.23±1.05)分、(10.90±1.11)分、(10.10±1.06)分、(9.94±1.06)分、(9.60±0.83)分,均低于PKP组的(17.55±0.71)分、(15.78±0.86)分、(13.42±0.92)分、(10.67±0.78)分、(9.78±0.72)分(P<0.05或0.01);VAS分别为(3.02±0.60)分、(2.96±0.55)分、(2.92±0.57)分、(2.88±0.61)分、(2.70±0.51)分,均低于PKP组的(3.60±0.57)分、(3.47±0.55)分、(3.32±0.46)分、(2.99±0.47)分、(2.77±0.42)分(P<0.05或0.01);ODI分别为14.43±1.29、14.54±1.24、14.63±1.32、14.37±1.31、13.42±1.45,均低于PKP组的16.72±1.64、16.06±1.49、14.82±1.53、14.74±1.46、13.69±1.75(P<0.05或0.01)。PKP结合对侧阻滞组骨水泥渗漏发生率为12.0%(10/83),PKP组为11.5%(9/78)(P>0.05)。两组均未出现神经血管损伤、肺栓塞及邻椎骨折等其他并发症。结论对于老年腰椎OVCF,单侧PKP结合对侧脊神经后内侧支阻滞术在手术时间、术中出血量、住院时间、复位效果及并发症发生率方面与单侧PKP相似,但患者疼痛缓解更明显,功能恢复更满意。

Objective To compare the efficacy of unilateral percutaneous kyphoplasty(PKP)and unilateral PKP combined with posterior medial branch block of the contralateral spinal nerve in the treatment of lumbar osteoporotic vertebral compression fracture(OVCF)in the elderly.Methods A retrospective cohort study was conducted to analyze the clinical data of 161 aged patients with newly developed lumbar OVCF,admitted to Xi′an Central Hospital Affiliated to Xi′an Jiaotong University School of Medicine from January 2019 to January 2023,including 58 males and 103 females,aged 61-88[(72.9±6.3)years].All the patients were diagnosed with type Ⅱ compression fracture based on acute symptomatic osteoporotic thoracolumbar fracture classification(ASOTLF).Seventy-eight patients underwent unilateral PKP(PKP group),while the other 83 patients underwent unilateral PKP combined with posterior medial branch block of the contralateral spinal nerve(PKP+contralateral block group).The operation time,intraoperative blood loss,and length of hospital stay were recorded.Beck index of the injured vertebra,Cobb angle of lumbar lordosis,Roland-Morris disability(RMD)score,visual analogue scale(VAS),and Oswestry disability index(ODI)were evaluated before operation,at 1 day,1 week,1 month,3 months after operation,and at the last follow-up.The incidence of complications such as cement leakage was recorded as well.Results All the patients were followed up for 6-8 months[(6.7±0.6)months].There were no significant differences between the two groups in the operation time,intraoperative blood loss,or length of hospital stay(P>0.05).The Beck index of the injured vertebra and Cobb angle of lumbar lordosis were not significantly different between the two groups before operation,at 1 day,1 week,1 month,3 months after operation,and at the last follow-up(P>0.05).The RMD score of the injured vertebra,VAS score,and ODI were not significantly different between the two groups before operation(P>0.05).At 1 day,1 week,1 month,3 months after operation,and at the last follow-up,the RMD scores in the PKP+contralateral block group were(11.23±1.05)points,(10.90±1.11)points,(10.10±1.06)points,(9.94±1.06)points,and(9.60±0.83)points respectively,which were all lower than(17.55±0.71)points,(15.78±0.86)points,(13.42±0.92)points,(10.67±0.78)points,and(9.78±0.72)points in the PKP group(P<0.05 or 0.01);the VAS scores in the PKP+contralateral block group were(3.02±0.60)points,(2.96±0.55)points,(2.92±0.57)points,(2.88±0.61)points,and(2.70±0.51)points respectively,which were all lower than(3.60±0.57)points,(3.47±0.55)points,(3.32±0.46)points,(2.99±0.47)points,and(2.77±0.42)points in the PKP group(P<0.05 or 0.01);the ODI values in the PKP+contralateral block group were 14.43±1.29,14.54±1.24,14.63±1.32,14.37±1.31,and 13.42±1.45 respectively,which were all lower than 16.72±1.64,16.09±1.49,14.82±1.53,14.74±1.46,and 13.69±1.75 in the PKP group(P<0.05 or 0.01).The bone cement leakage rate was 12.0%(10/83)in the PKP+contralateral block group,similar to 11.5%(9/78)in the PKP group(P>0.05).No other complications such as neurovascular injury,pulmonary embolism or adjacent vertebral fracture were found in either groups.Conclusion In the treatment of lumbar OVCF in the elderly,unilateral PKP combined with posterior medial branch block of the contralateral spinal nerve is similar to unilateral PKP in terms of the operation time,intraoperative blood loss,length of hospital stay,effectiveness of reduction,and incidence of complications,but it can achieve better pain relief and more satisfactory functional recovery.