摘要
目的:探讨经皮弯曲椎体成形术(percutaneous curve kyphoplasty,PCKP)与单侧椎体后凸成形术(unilateral kyphoplasty,UPKP)在胸腰段骨质疏松椎体压缩骨折(osteoporotic vertebral compression fractures,OVCF)治疗中的临床疗效差异,重点评估骨水泥分布、渗漏风险及椎体生物力学恢复效果。方法:纳入2022年1月至2024年4月收治的78例急性胸腰段OVCF患者,根据手术方法分为PCKP组37例与UPKP组41例。PCKP组37例,男12例,女25例,年龄(78.84±11.24)岁,骨密度T值-4.05±0.81;UPKP组41例,男17例,女24例,年龄(77.68±10.73)岁,骨密度T值-4.15±0.82。比较两组术前及术后疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)、椎体前柱高度、骨水泥分布优良率、渗漏率及手术相关指标。结果:两组患者随访时间12个月,PCKP组VAS评分在术前及术后2d和术后3、12个月分别为(6.35±2.34)、(2.95±0.70)、(1.76±1.19)、(0.97±0.80)分,UPKP组分别为(6.83±2.23)、(3.15±0.82)、(1.73±1.12)、(1.17±0.74)分。PCKP组ODI评分在术前及术后2d和术后3、12个月分别为(75.73±3.42)、(34.57±3.18)、(24.03±5.24)、(22.84±1.68)分,UPKP组分别为(74.41±2.85)、(35.54±3.49)、(24.95±2.85)、(22.66±1.70)分。两组术后VAS、ODI评分均显著改善(P<0.05),但组间比较差异无统计学意义(P>0.05)。PCKP组骨水泥分布优良率为91.89%(34/37),高于UPKP组65.85%(27/41),两组比较差异有统计学意义(P=0.001);PCKP组渗漏率为13.51%(5/37),优于UPKP组34.15%(14/41),两组比较差异有统计学意义(P=0.030)。两组骨水泥不良分布者和渗漏者椎体压缩程度比较,差异无统计学意义(P>0.05)。PCKP组椎体前柱高度术前(13.22±2.47)mm,术后2 d(16.68±1.42)mm;UPKP组术前(13.80±2.50)mm,术后2 d(17.02±1.35)mm;两组术后2d椎体前柱高度均较术前显著恢复(P<0.05),但组间比较差异无统计学意义(P>0.05)。PC KP组再骨折4例,UPKP组6例,两组比较差异无统计学意义(P>0.05)。两组手术时间及透视次数比较,差异均无统计学意义(P>0.05)。结论:PCKP通过弧形骨钻技术优化骨水泥双侧弥散,显著提升分布均匀性并降低渗漏风险,尤其适用于中重度压缩骨折;其单侧穿刺、低压灌注的技术特点在不增加手术时间与辐射暴露的前提下,为胸腰段OVCF提供了更安全有效的微创解决方案。未来需扩大样本量并延长随访以验证其远期生物力学优势。
Objective To investigate the differences in clinical efficacy between percutaneous curved kyphoplasty(PCKP)and unilateral percutaneous kyphoplasty(UPKP)in the treatment of thoracolumbar osteoporotic vertebral compression fractures(OVCF),with a focus on evaluating cement distribution,leakage risk,and vertebral biomechanical restoration.Methods A total of 78 patients with acute thoracolumbar OVCF admitted between January 2022 and April 2024 were included.They were divided into a PCKP group and a UPKP group based on the surgical technique.The PCKP group comprised 37 cases,including 12 males and 25 females,with an age of(78.84±11.24)years and a bone mineral density T value of−4.05±0.81.The UPKP group included 41 cases,comprising 17 males and 24 females,with an age of(77.68±10.73)years and a bone mineral density T value of-4.15±0.82.Comparisons were made between the two groups regarding preoperative and postoperative visual analogue scale(VAS)pain scores,Oswestry disability index(ODI)scores,anterior vertebral body height,rate of good/excellent cement distribution,cement leakage rate,and surgery-related parameters.Results All patients were followed up for 12 months.In the PCKP group,the mean VAS preoperatively,and at 2 days,3 months,and 12 months postoperatively were(6.35±2.34),(2.95±0.70),(1.76±1.19),and(0.97±0.80)points,respectively.Corresponding scores in the UPKP group were(6.83±2.23),(3.15±0.82),(1.73±1.12),and(1.17±0.74)points.The mean ODI scores in the PCKP group at the same time points were(75.73±3.42),(34.57±3.18),(24.03±5.24),and(22.84±1.68)points,respectively,compared to(74.41±2.85),(35.54±3.49),(24.95±2.85),and(22.66±1.70)points in the UPKP group.Both groups showed significant improvement in VAS and ODI scores postoperatively(P<0.05),but no statistically significant differences were observed between the groups(P>0.05).The rate of good/excellent cement distribution in the PCKP group was 91.89%(34/37),significantly higher than the 65.85%(27/41)in the UPKP group(P=0.001).The cement leakage rate was 13.51%(5/37)in the PCKP group,which was significantly lower than the 34.15%(14/41)in the UPKP group(P=0.030).No significant difference was found in the degree of vertebral compression between patients with poor cement distribution/leakage and those without in either group(P>0.05).The mean anterior vertebral body height in the PCKP group increased from(13.22±2.47)mm preoperatively to(16.68±1.42)mm at 2 days postoperatively.In the UPKP group,it increased from(13.80±2.50)mm to(17.02±1.35)mm at 2 days postoperatively.Both groups showed significant restoration of anterior vertebral height postoperatively(P<0.05),with no significant intergroup difference(P>0.05).Re-fractures occurred in 4 cases in the PCKP group and 6 cases in the UPKP group,showing no significant intergroup difference(P>0.05).No significant differences were found in operative time or fluoroscopy frequency between the two groups(P>0.05).Conclusion PCKP,utilizing a curved drill technique,optimizes bilateral cement dispersion,significantly improving distribution uniformity and reducing leakage risk,making it particularly suitable for moderate-to-severe compression fractures.Its technical characteristics such as unilateral puncture and low-pressure cement infusion-provide a safer and more effective minimally invasive solution for thoracolumbar OVCF without increasing operative time or radiation exposure.Future studies with larger sample sizes and longer follow-up are needed to verify its long-term biomechanical advantages.
作者
杨富国
罗园超
陈康
何仁建
Yang Fuguo;Luo Yuanchao;Chen Kang;He Renjian(Department of Orthopaedics,the First People's Hospital of Zigong City,Zigong 643000,Sichuan,China)
出处
《中国骨伤》
2026年第2期130-137,共8页
China Journal of Orthopaedics and Traumatology
基金
自贡市科学技术局重点研发项目(编号:ZC202001)。
