单球囊单侧跨中线扩张改良PKP术治疗OVCF的临床疗效分析  

Clinical efficacy analysis of single-balloon unilateral trans-midline expansion with modified PKP for OVCF

作　　者：郑义朋 谷同同 刘康[1] 王谦[2] 王岩峰 ZHENG Yipeng;GU Tongtong;LIU Kang;WANG Qian;WANG Yanfeng(Orthopedics,Baoding Second Central Hospital,Baoding 072750,China;Radiology Department,Baoding Second Central Hospital,Baoding 072750,China)

机构地区：[1]保定市第二中心医院骨科,保定072750 [2]保定市第二中心医院放射科,保定072750

出　　处：《湖南师范大学学报（医学版）》2024年第4期110-115,共6页Journal of Hunan Normal University(Medical Sciences)

基　　金：河北省医学科学研究课题计划“骨质疏松性椎体骨折术后再骨折风险自评预测模型的建立”(20232023)。

摘　　要：目的:探究单球囊单侧跨中线扩张改良经皮球囊扩张椎体后凸成形术(percutaneous balloon expansion kyphoplasty,PKP)治疗骨质疏松椎体压缩性骨折(osteoporotic vertebral compression fractures,OVCF)的效果。方法:选取2021年8月—2022年6月我院115例OVCF患者,根据手术方法不同分组,57例采用常规双侧椎弓根穿刺PKP,为对照组,58例采用单球囊单侧跨中线扩张改良PKP治疗,作为研究组。比较两组手术情况、手术前后创伤应激指标[前列腺素E_(2)(PGE_(2))、去甲肾上腺素(NE)、P物质(SP)]、脊柱骨盆矢状面平衡参数[伤椎高度丢失率、Cobb角、矢状面偏移(SVA)、胸椎后凸角(TK)、腰椎前凸角(LL)、骨盆入射角(PI)、骨盆倾斜角(PT)、骶骨倾斜角(SS)]、腰椎功能(ODI评分、JOA评分)、疼痛程度(VAS评分)、术后残余背痛发生率。结果:研究组手术时间、术中透视次数少于对照组,骨水泥注入量高于对照组;术后1、3、7 d研究组血清PGE_(2)、NE、SP水平均较对照组低;术后3、6个月研究组伤椎高度丢失率、Cobb角、SVA、TK、LL、PI、PT、SS与对照组比较,均无显著差异;术后3、6个月研究组ODI、JOA及VAS评分与对照组比较,无显著差异;研究组术后残余背痛发生率均较对照组低。结论:单球囊单侧跨中线扩张改良PKP与常规双侧椎弓根穿刺PKP治疗OVCF均能纠正脊柱骨盆结构,恢复腰椎功能,缓解患者疼痛,而前者能进一步优化手术,减少术中透视次数,降低组织损伤,降低术后残余背痛风险,但会增加骨水泥用量。Objective To investigate the efficacy of single balloon unilateral transmedial dilatation modified percutaneous balloon dilatation vertebral kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fractures (OVCF).Methods A total of 115 patients with OVCF in our hospital from August 2021 to June 2022 were selected and grouped according to different surgical methods.Among them,58 patients were treated with unilateral transmidline dilated PKP with single balloon as the study group,and 57 patients were treated with bilateral pedicle PKP as the control group.The surgical conditions,traumatic stress indexes [prostaglandin E2(PGE2),noadrenaline (NE),Substance P (SP)]before and after surgery,spinal and pelvic sagittal balance parameters [loss rate of injured vertebra height,Cobb Angle,sagittal deviation (SVA),thoracic kyphosis Angle (TK),lumbar lordosis Angle (LL),pelvic incidence Angle (PI),Pelvic inclination Angle (PT),sacral inclination Angle (SS)],lumbar function (ODI score,JOA score),pain degree (VAS score),bone turnover markers [type Ⅰ collagen cross-linked carboxy-terminal peptide (CTx),β-collagen degradation products (β-CTx),type Ⅰ procollagen amino terminal propeptide (PINP)],incidence of postoperative adverse events.Results The surgery time and intraoperative fluoroscopy frequency in the study group were less than those in the control group,and the amount of bone cement injection was higher than that in the control group;The serum levels of PGE2,NE,and SP in the study group were lower than those in the control group on the 1st,3rd,and 7th day after surgery;There was no significant difference in the loss rate of vertebral height,Cobb angle,SVA,TK,LL,PI,PT,SS between the study group and the control group at 3 and 6 months after surgery;There was no significant difference in ODI,JOA,and VAS scores between the study group and the control group at 3 and 6 months after surgery;The incidence of postoperative residual back pain in the study group was lower than that in the control group.Conclusi

关 键 词：骨质疏松 椎体压缩性骨折 经皮球囊扩张椎体后凸成形术 单球囊 创伤应激指标 

分 类 号：R683[医药卫生—骨科学]