横突椎弓根入路行经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折的疗效分析  

Percutaneous kyphoplasty through transverse pedicle approach for osteoporotic vertebral compression fractures

作　　者：王昕 乔宇 胡骏 刘毅 赵志刚[1] Wang Xin;Qiao Yu;Hu Jun;Liu Yi;Zhao Zhigang(Department of Spine Surgery,The Fourth Hospital of Wuhan,Wuhan 430035,China)

机构地区：[1]武汉市第四医院脊柱外科,武汉430035 [2]江汉大学医学院,武汉430056

出　　处：《中华创伤骨科杂志》2023年第4期328-334,共7页Chinese Journal of Orthopaedic Trauma

摘　　要：目的:通过与传统椎弓根入路(CTA)行经皮椎体后凸成形术(PKP)比较,探讨采用横突椎弓根入路(TPPA)行PKP治疗骨质疏松性椎体压缩骨折(OVCF)的疗效。方法:回顾性研究2020年8月至2021年8月期间武汉市第四医院脊柱外科收治的101例单节段OVCF患者资料。男31例,女70例;年龄(70.3±7.6)岁;骨密度T值-3.0±0.3。根据手术入路不同分为TPPA组(52例,采用TPPA行PKP术)和CTA组(49例,采用CTA行PKP术)。通过比较两组患者的手术时间、术中透视次数、骨水泥分布优良率、骨水泥渗漏率,术前、术后24 h、3个月、6个月的疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、Beck指数,以及再骨折情况评价疗效。结果:两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。所有患者术后随访(9.8±1.5)个月。所有患者均顺利完成手术,未发生神经损伤或椎弓根骨折等并发症。两组患者的手术时间、术中透视次数、骨水泥渗漏率比较差异均无统计学意义(P>0.05)。TPPA组骨水泥分布优良率92.3%(48/52)显著高于CTA组61.2%(30/49),术后24 h VAS评分[3.0(2.0,4.0)分]、ODI(57.2±4.6)均显著低于CTA组[4.0(3.0,4.0)分、59.2±5.3],差异均有统计学意义(P<0.05);两组的VAS评分、ODI在术前、术后3、6个月比较差异均无统计学意义(P>0.05)。同一组内VAS评分、ODI逐步改善,各个时间点间比较差异均有统计学意义(P<0.05)。TPPA组术后24 h、6个月的Beck指数[0.81(0.69,0.86)、0.76(0.67,0.81)]均显著高于CTA组[0.75(0.71,0.79)、0.72(0.68,0.77)],差异均有统计学意义(P<0.05);所有患者术后24 h、6个月Beck指数较术前改善,差异均有统计学意义(P<0.05)。结论:采用TPPA行PKP治疗OVCF较CTA具有同样的手术安全性,但具有更好的骨水泥分布,在术后即刻可更好地缓解疼痛,并且在恢复及保持伤椎高度方面更有优势。Objective To investigate the clinical efficacy of percutaneous kyphoplasty(PKP)through the transverse process-pedicle approach(TPPA)by comparing with PKP through the conventional transpedicle approach(CTA).Methods A retrospective study was conducted to analyze the data of 101 patients with single-segment osteoporotic vertebral compression fracture(OVCF)who had been treated at Department of Spine Surgery,The Fourth Hospital of Wuhan from August 2020 to August 2021.There were 31 males and 70 females,with an age of(70.3±7.6)years.Their T values of bone mineral density averaged(-3.0±0.3).They were divided into a TPPA group of 52 cases in which PKP was performed through the TPPA and a CTA group of 49 cases in which PKP was performed through the CTA.The clinical efficacy was evaluated by comparing the 2 groups in terms of operation time,frequency of intraoperative fluoroscopy,excellent to good rate of bone cement distribution,rate of bone cement leakage,refractures,and visual analogue scale(VAS),Oswestry disability index(ODI)and Beck index at preoperation,24 hours,3 months and 6 months postoperation.Results There was no significant difference in the preoperative general data between the 2 groups,showing they were comparable(P>0.05).All the patients were followed up for(9.8±1.5)months.Operations were completed successfully in all patients with no complications like nerve injury or pedicle fracture.There were no significant differences in operation time,frequency of intraoperative fluoroscopy or rate of bone cement leakage between the 2 groups(P>0.05).In the TPPA group,the excellent to good rate of bone cement distribution[92.3%(48/52)]was significantly higher than that in the CTA group[61.2%(30/49)],the VAS score[3.0(2.0,4.0)]and ODI(57.2±4.6)at 24 hours postoperation were significantly lower than those in the CTA group[4.0(3.0,4.0)and 59.2±5.3](P<0.05).There were no significant differences in VAS or ODI between the 2 groups at preoperation,3 months or 6 months postoperation(P>0.05).The VAS and ODI improved steadil

关 键 词：骨质疏松 脊柱骨折 椎体成形术 横突椎弓根入路 

分 类 号：R687.3[医药卫生—骨科学]