单、双侧穿刺经皮椎体后凸成形术治疗骨质疏松椎体压缩性骨折对手术区域冠状面侧凸Cobb角的影响

Effect of surgical area of cross-sectional scoliosis Cobb angle between unilateral and bilateral PKP for osteoporotic vertebral compression fractures

目的探讨单、双侧穿刺经皮椎体后凸成形术(PKP)治疗骨质疏松椎体压缩性骨折对手术区域冠状面侧凸Cobb角的影响。方法回顾性分析2010年1月至2014年6月在济宁医学院附属医院脊柱外科行PKP治疗的骨质疏松性椎体压缩性骨折的病例。采用随机对照研究,根据入院先后顺序,单数行单侧经皮穿刺球囊扩张椎体后凸成形术(单侧PKP患者40例),偶数行双侧经皮穿刺球囊扩张椎体后凸成形术(双侧PKP患者35例),同时抗骨质疏松药物治疗。收集患者一般资料:年龄、性别、骨折椎体数、骨折节段、腰痛时间,评估术前和术后疼痛视觉模拟量表(VAS)评分,Oswestry功能障碍指数(ODI),测量术前和术后手术区域冠状面侧凸Cobb角。统计两治疗组病例围手术期及术后随访的临床资料,分析对比两组间各项指标之间的差异是否具有相关性及统计学意义。结果两组一般资料比较差异无统计学意义(P>0.05),75例患者均获得随访,随访12~36个月,平均24.6个月,VAS评分:两组组内术后末次随访与术后1周、术前,术后1周与术前比较差异均有统计学意义(P<0.05),两组组间比较差异无统计学意义(P>0.05);ODI:术后末次随访与本组术后1周、术前,术后1周与术前数据比较,两治疗组差异均有统计学意义(P<0.05),末次随访两组组间比较差异有统计学意义(P<0.05);冠状面侧凸Cobb角组内术后1周与术前、末次随访,术前与末次随访比较差异有统计学意义(P<0.05),且两组组间末次随访比较差异有统计学意义(P<0.05);术后1周、末次随访时双侧穿刺组冠状面侧凸Cobb角度纠正与ODI呈正相关(r=0.881,P<0.05)。结论对于骨质疏松性椎体压缩性骨折患者,采用单侧或双侧经椎弓根行PKP的方法均可缓解疼痛,随着时间的延长,在纠正手术区域横断面侧凸畸形、ODI方面经双侧的方法疗效要优于单侧。

Objective To investigate the effect of surgical area of coronal plane kyphotic Cobb angle between unilateral and bilateral PKP for osteoporotic centrum compression fractures. Methods To retrospectively analyze between January 2010 and June 2014, with PKP in treatment of osteoporotic vertebral compression fractures 75 cases, the clinical data were analysed via randomized control trial. According to admission time, singular numbers were operated via unipedicular PKP(40 cases), even numbers were operated via unipedicular PKP(35 cases); All patients were treated via anti-osteoporosis drugs. General information: age, gender, number of vertebral fractures, fracture segment, low back pain, since the date of hospital evaluation of preoperative and postoperative pain visual analog scale(visual analog scale, VAS) score, Oswestry disability index(ODI), measured the preoperative and postoperative surgical area of coronal plane scoliosis Cobb. Compared the preoperative and postoperative follow-up clinical data, indicators between the two groups. Results There was no significant difference in general data(P>0.05), 75 patients were followed up for 12 to 36 months, average 24.6 months, the VAS score, two groups of postoperative patients with the last follow-up and 1 weeks before operation, one week before the operation and the data were compared, the difference between the two treatment groups were statistically significant(P<0.05), there was no significant difference between the two groups(P>0.05); Oswestry disability index: postoperative follow-up and the postoperative 1 week, preoperative, postoperative and preoperative data, differences between the two treatment groups were statistically significant(P<0.05), at the end of the follow-up of unilateral and bilateral group were compared with statistical significance(P<0.05). Before operation and at last follow-up, the difference had statistical significance(P<0.05), and single and bilateral group at the time of the last follow-up the difference had statistical significance(P<0.05); and the coronal Cobb perspective correction was positively correlated with ODI(r=0.881, P<0.05). Conclusions For osteoporotic vertebral compression fractures in patients, unilateral or bilateral approach with PKP method can achieve good pain relief effect, but with follow-up flying, in the ODI and correct surgical area of coronal plane scoliosis cobb angle regard, the bilateral approach is superior to unilateral effects.