不同入路经皮球囊扩张椎体后凸成形术治疗胸腰椎压缩性骨折的临床观察

Observation of therapeutic effect of percutaneous balloon kyphoplasty with different approaches on thoracolumbar compression fractures

目的比较不同入路经皮球囊扩张椎体后凸成形术(PKP)治疗胸腰椎压缩性骨折的临床效果。方法回顾性抽取2020年4月至2023年4月于新乡医学院第一附属医院行PKP治疗的胸腰椎压缩性骨折患者83例,依据PKP入路方式将其分为单侧组(39例,经单侧椎弓根穿刺入路)和双侧组(44例,经双侧椎弓根穿刺入路)。比较两组术中指标及术后并发症发生情况,评估并比较两组不同时间点疼痛程度[数字等级评分法(NRS)]、腰椎功能[Oswestry功能障碍指数(ODI)]、椎体恢复情况(前缘高度、中间高度及后凸Cobb角)。结果单侧组手术时间短于双侧组,透视次数、骨水泥用量少于双侧组(P<0.05)。两组术后并发症发生率比较,差异未见统计学意义(P>0.05)。术前至术后6个月,两组NRS、ODI评分逐渐下降(P<0.05);术后3 d、术后6个月,两组椎体前缘高度、中间高度高于术前,后凸Cobb角小于术前(P<0.05)。两组NRS评分、ODI评分、椎体前缘高度、中间高度、后凸Cobb角时点比较差异有统计学意义(P<0.05),组间、组间·时点比较,差异未见统计学意义(P>0.05)。结论单侧与双侧椎弓根穿刺入路PKP治疗胸腰椎压缩性骨折的临床效果和安全性相当,但单侧入路手术时间更短,透视次数、骨水泥用量更少。

Objective To compare the clinical effects of percutaneous balloon kyphoplasty(PKP)with different approaches on thoracolumbar compression fractures.Methods A total of 83 patients with thoracolumbar compression fracture who underwent PKP treatment in the First Affiliated Hospital of Xinxiang Medical University from April 2020 to April 2023 were retrospectively selected,and they were divided into a unilateral group(39 cases,treated by transpedicle puncture approach)and a bilateral group(44 cases,treated by bilateral pedicle puncture approach)according to the PKP approach.The intraoperative indexes and postoperative complications were compared between the two groups.The pain level assessed by the numerical rating scale(NRS),the lumbar spine function assessed by the Oswestry dysfunction index(ODI),and the vertebral recovery(anterior edge height,median height and kyphotic Cobb angle)were evaluated and compared between the two groups.Results The operation time in the unilateral group was shorter than that in the bilateral group,while the frequency of fluoroscopy and bone cement volume in the unilateral group were lower than those in the bilateral group(P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).The scores of NRS and ODI in the two groups decreased gradually from preoperative to postoperative 6 months(P<0.05).Compared with preoperative indexes,the height of the anterior edge and the middle height of the vertebral body in the two groups were higher,and kyphotic Cobb angle in the two groups were smaller 3 days and 6 months after surgery(P<0.05).There were significant differences in NRS score,ODI score,anterior edge height,middle height and kyphotic Cobb angle between the two groups at each time point(P<0.05);there were no statistically significant differences in the intergroup and different-time intergroup comparisons of the above indexes of the two groups(P>0.05).Conclusions The clinical efficacy and safety of PKP with unilateral and bilateral pedicle puncture approaches are comparable in the treatment of thoracolumbar compression fractures;but the unilateral approach has shorter operation time,require fewer times of fluoroscopy and less cement.