[1]王宝虎,邬博来,马智敏,等.单侧与双侧椎弓根入路经皮椎体后凸成形术治疗骨质疏松性椎体侧方压缩性骨折的对比研究[J].中医正骨,2021,33(08):16-22.
　WANG Baohu,WU Bolai,MA Zhimin,et al.A comparative study of percutaneous kyphoplasty through unipedicular approach versus bipedicular approach for treatment of lateral osteoporotic vertebral compression fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(08):16-22.
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单侧与双侧椎弓根入路经皮椎体后凸成形术治疗骨质疏松性椎体侧方压缩性骨折的对比研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期数:
2021年08期
页码:
16-22
栏目:
临床研究
出版日期:
2021-08-20

文章信息/Info

Title:
A comparative study of percutaneous kyphoplasty through unipedicular approach versus bipedicular approach for treatment of lateral osteoporotic vertebral compression fractures
作者:
王宝虎; 邬博来; 马智敏; 吴乐彬
(湖州市中医院,浙江 湖州 313000)
Author(s):
WANG Baohu; WU Bolai; MA Zhimin; WU Lebin
Huzhou Hospital of Traditional Chinese Medicine,Huzhou 313000,Zhejiang,China
关键词:
骨质疏松性骨折;  骨折; 压缩性;  胸椎;  腰椎;  椎体后凸成形术;  手术入路;  临床试验
Keywords:
osteoporotic fractures;  fractures; compression;  thoracic vertebrae;  lumbar vertebrae;  kyphoplasty;  operative approach;  clinical trial
摘要:
目的:比较单侧与双侧椎弓根入路经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松性椎体侧方压缩性骨折的临床疗效。方法:回顾性分析54例骨质疏松性椎体侧方压缩性骨折患者的病例资料,其中采用单侧椎弓根入路PKP治疗23例(单侧入路组),采用双侧椎弓根入路PKP治疗31例(双侧入路组)。男16例,女38例。年龄55～91岁,中位数71.5岁。比较2组患者术后1周骨水泥弥散系数,术前及术后1个月、6个月、12个月、24个月椎体压缩侧凸角、腰背部疼痛视觉模拟量表(visual analogue scale,VAS)评分及Oswestry功能障碍指数(Oswestry disability index,ODI)评分。结果:①骨水泥弥散系数。术后1周,单侧入路组骨水泥弥散系数低于双侧入路组(17.12±5.14)%,(28.07±3.29)%,t=51.740,P=0.001]。②椎体压缩侧凸角。时间因素和分组因素不存在交互效应(F=4.107,P=0.074); 2组患者椎体压缩侧凸角总体比较,组间差异无统计学意义,即不存在分组效应(F=8.371,P=0.241); 手术前后不同时间点椎体压缩侧凸角的差异有统计学意义,即存在时间效应(F=428.107,P=0.000); 2组患者椎体压缩侧凸角随时间变化均呈下降趋势,且2组的下降趋势完全一致(单侧入路组:23.17°±3.51°,10.84°±2.53°,10.77°±2.61°,10.75°±2.70°,10.71°±2.73°,F=532.236,P=0.000; 双侧入路组:25.08°±2.78°,9.70°±1.81°,9.67°±2.17°,9.69°±2.28°,9.69°±2.32°,F=219.463,P=0.000)。③腰背部疼痛VAS评分。时间因素和分组因素存在交互效应(F=3.805,P=0.005); 2组患者腰背部疼痛VAS评分总体比较,组间差异有统计学意义,即存在分组效应(F=18.963,P=0.014); 手术前后不同时间点腰背部疼痛VAS评分的差异有统计学意义,即存在时间效应(F=394.152,P=0.000); 2组患者腰背部疼痛VAS评分随时间变化均呈下降趋势,但2组的下降趋势不完全一致[单侧入路组:(8.1±2.1)分,(3.2±0.5)分,(2.7±0.5)分,(2.9±0.5)分,(3.1±0.4)分,F=414.275,P=0.000; 双侧入路组:(8.3±1.6)分,(2.9±0.4)分,(2.4±0.4)分,(2.2±0.4)分,(2.0±0.4)分,F=374.551,P=0.000]; 术前及术后1个月,2组患者腰背部疼痛VAS评分的组间差异均无统计学意义(t=0.317,P=0.714; t=5.271,P=0.410); 术后6个月、12个月、24个月,单侧入路组腰背部疼痛VAS评分均高于双侧入路组(t=6.711,P=0.033; t=10.724,P=0.018; t=11.254,P=0.022)。④ODI评分。时间因素和分组因素存在交互效应(F=2.127,P=0.007); 2组患者ODI评分总体比较,组间差异有统计学意义,即存在分组效应(F=316.788,P=0.038); 手术前后不同时间点ODI评分的差异有统计学意义,即存在时间效应(F=517.438,P=0.000); 2组患者ODI评分随时间变化均呈下降趋势,但2组的下降趋势不完全一致[单侧入路组:(39.04±3.79)分,(17.28±2.73)分,(14.78±1.17)分,(17.41±1.18)分,(16.94±2.23)分,F=379.616,P=0.000; 双侧入路组:(35.08±2.78)分,(16.47±2.69)分,(15.34±2.56)分,(13.55±2.07)分,(12.74±1.57)分,F=307.398,P=0.000]; 术前及术后1个月、6个月,2组患者ODI评分的组间差异均无统计学意义(t=1.273,P=0.548; t=13.127,P=0.109; t=18.074,P=0.074); 术后12个月、24个月,单侧入路组ODI评分均高于双侧入路组(t=18.981,P=0.021; t=21.279,P=0.014)。结论:相较于单侧椎弓根入路PKP,双侧椎弓根入路PKP治疗骨质疏松性椎体侧方压缩性骨折,能更好地促使骨水泥弥散、缓解腰背部疼痛、改善胸腰椎功能,但二者在纠正椎体侧凸畸形方面疗效相当。
Abstract:
Objective:To compare the clinical curative effects of percutaneous kyphoplasty(PKP)through unipedicular approach versus bipedicular approach for treatment of lateral osteoporotic vertebral compression fractures(OVCFs).Methods:The medical records of 54 patients with lateral OVCFs were analyzed retrospectively.Twenty-three patients were treated with PKP through unipedicular approach(unipedicular approach group),while the others were treated with PKP through bipedicular approach(bipedicular approach group).The patients consisted of 16 males and 38 females,and ranged in age from 55 to 91 years(Median=71.5 yrs).The bone cement diffusion coefficient measured at 1 week after the surgery and the vertebral compression scoliosis angle,low back pain visual analogue scale(VAS)scores and Oswestry disability index(ODI)scores evaluated before the surgery and at 1 month,6,12 and 24 months after the surgery were compared between the 2 groups respectively.Results:The bone cement diffusion coefficient was lower in unipedicular approach group compared to bipedicular approach group at 1 week after the surgery(17.12±5.14 vs 28.07±3.29%,t=51.740,P=0.001).There was no interaction between time factor and group factor in vertebral compression scoliosis angle(F=4.107,P=0.074).There was no statistical difference in vertebral compression scoliosis angle between the 2 groups in general,in other words,there was no group effect(F=8.371,P=0.241).There was statistical difference in vertebral compression scoliosis angle between different timepoints before and after the surgery,in other words,there was time effect(F=428.107,P=0.000).The vertebral compression scoliosis angle presented a time-dependent decreasing trend in the 2 groups,and the 2 groups were exactly consistent with each other in the variation tendency(unipedicular approach group:23.17±3.51,10.84±2.53,10.77±2.61,10.75±2.70,10.71±2.73 degrees,F=532.236,P=0.000; bipedicular approach group:25.08±2.78,9.70±1.81,9.67±2.17,9.69±2.28,9.69±2.32 degrees,F=219.463,P=0.000).There was interaction between time factor and group factor in low back pain VAS scores(F=3.805,P=0.005).There was statistical difference in low back pain VAS scores between the 2 groups in general,in other words,there was group effect(F=18.963,P=0.014).There was statistical difference in low back pain VAS scores between different timepoints before and after the surgery,in other words,there was time effect(F=394.152,P=0.000).The low back pain VAS scores presented a time-dependent decreasing trend in the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(unipedicular approach group:8.1±2.1,3.2±0.5,2.7±0.5,2.9±0.5,3.1±0.4 points,F=414.275,P=0.000; bipedicular approach group:8.3±1.6,2.9±0.4,2.4±0.4,2.2±0.4,2.0±0.4 points,F=374.551,P=0.000).The comparison of low back pain VAS scores between the 2 groups revealed no significant differences before the surgery and at 1 month after the surgery(t=0.317,P=0.714; t=5.271,P=0.410); while,at 6,12 and 24 months after the surgery,the low back pain VAS scores were higher in unipedicular approach group compared to bipedicular approach group(t=6.711,P=0.033; t=10.724,P=0.018; t=11.254,P=0.022)...

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