不同入路方式在PKP治疗胸腰椎压缩性骨折中的对比研究

Comparative study of two different approaches in PKP treatment of thoracic compression fractures

目的探讨两种不同入路方式在经皮椎体后凸成形术(PKP)治疗胸腰椎压缩性骨折中的效果。方法选择2022年6月至2023年6月本院182例胸腰椎压缩性骨折患者,根据随机数字表法实施分组,对照组91例采用双侧椎弓根旁入路PKP治疗,研究组91例行单侧椎弓根旁入路PKP治疗,两组均随访6个月。观察两组疼痛程度及椎体功能恢复情况、手术时间、骨水泥注射量、透视时间、术后并发症发生情况。结果两组术后1周的视觉模拟评分法(VAS)评分与本组术前相比均更低,且研究组低于对照组(P<0.05);两组随访6个月的日本矫形外科协会(JOA)评分均高于术前,但两组间对比差异不明显(P>0.05);研究组手术时间及透视时间短于对照组,且骨水泥注射量少于对照组(P<0.05);研究组术后并发症总发生率低于对照组(P<0.05)。结论双侧、单侧椎弓根旁入路PKP均为临床治疗胸腰椎压缩性骨折的有效方式,有助于改善恢复椎体功能,但后者手术时间及透视时间更短,且骨水泥注射量更少,更有助于减轻患者术后疼痛,降低并发症发生风险。

Objective To investigate the effect of two different approaches in the treatment of thoracic compression fractures with PKP.Methods A total of 182 patients with thoracic compression fracture in our hospital from June 2022 to June 2023 were selected and grouped according to random number table method.91 patients in the reference group received bilateral parapedicle approach PKP,while 91 patients in the study group received unilateral parapedicle approach PKP.Both groups were followed up for 6 months.The vertebral height recovery,pain degree and vertebral function recovery of the two groups were observed.The operation time,bone cement injection amount and fluoroscopy time of the two groups were counted,and the incidence of postoperative complications were compared.Results After 6 months of follow-up,the vertebral anterior margin height and middle height of the two groups were higher than before surgery,while the compression rate of the vertebral anterior margin height was lower than before surgery(P<0.05),but there was no significant difference between the two groups(P>0.05).The visual VAS score 1 week after surgery in both groups was lower than that before surgery,and the study group was lower than the reference group(P<0.05).The JOA scores of both groups at 6 months follow-up were higher than those before surgery,but there was no significant difference between the two groups(P>0.05).The operation time and fluoroscopy time of the study group were shorter than that of the reference group,and the injection amount of bone cement was lower than that of the reference group(P<0.05).The incidence of postoperative complications in the study group was lower than that in the reference group(P<0.05).Conclusion Both bilateral and unilateral parapedicle approach PKP are effective methods for the clinical treatment of thoracic compression fractures,which can help to improve the vertebral condition and restore the function of the vertebral body.However,unilateral parapedicle approach PKP treatment has shorter operation time and fluoroscopy time,and less bone cement injection amount,which is more helpful to alleviate postoperative pain and reduce the risk of complications.