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E2（PGE2）、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PGE2、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。
Abstract
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. Conclusion sBoth single-balloon unilateral transmedial expansion modified PKP and conventional bilateral arch puncture PKP for OVCF can correct the spinal pelvic architecture, restore lumbar function and relieve patient pain, while the former can further optimise the procedure, reduce the number of intraoperative fluoroscopies, reduce tissue damage and lower the risk of residual postoperative back pain, but increase the amount of bone cement used.
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
Key words
osteoporosis /
vertebral compression fracture /
percutaneous balloon expansion kyphoplasty /
single balloon /
traumatic stress index
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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）
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