Clinical observation of unilateral-beside approach PKP in treatment of lumbar OVCF

doi:10.3877/cma.j.issn.2096-0263.2021.03.003

Abstract

Abstract:

Objective

To compare the clinical effect of unilateral parapedicle approach and bilateral pedicle approach in the treatment of osteoporotic lumbar vertebral compression fractures.

Methods

From July 2017 to January 2019, 68 patients (73 vertebrae) with osteoporotic lumbar compression fractures treated by percutaneous vertebroplasty in our hospital were retrospectively analyzed. According to the surgical approach, they were divided into unilateral parapedicle approach group (unilateral group) with 32 cases (35 vertebrae) , including 7 males and 25 females, aged 61-79 years (average, 69.7±5.3) years, and the bilateral pedicle approach (bilateral group) had 36 patients (38 vertebrae), including 9 males and 27 females, aged 62-81 years, with an average of (71.5±6.8) years. The operation index, imaging index and dysfunction index of the two groups were compared.

Results

All patients in the two groups were followed up for 3-6 months. Patients in the two groups had significantly lower visual analogue scale (VAS) scores for lumbocrural pain and Oswestry Disability Index (ODI) before operation and 1 d and 3 months after operation (P<0.05). The operation time, intraoperative bleeding volume, fluoroscopic times, and bone cement injection volume in the unilateral group were (37±6) min, (15±3) mL, and (17±4) ml, respectively, which were less than those in the bilateral group [operation time: (51±8) min, intraoperative bleeding volume: (23±5) mL, and fluoroscopic times: (5.7±1.4) ml] (t=7.967, t=7.636, t=7.72, t=3.035, P<0.05). In the unilateral group, the Cobb angles of kyphosis were (9±3) and (10±3) one day and three months after surgery, (15±6)% and (15±6)% at the same time point, respectively. In the bilateral group, the Cobb angles of kyphosis were (10±3) and (10±3) one day and three months after surgery, respectively. The leading edge compression at the same time point was: (17±5)% and (16±6)%, respectively. The kyphoscolic Cobb angle and the compression of the leading edge of the vertebral body in the two groups were both improved after operation (P<0.05), but there were no significant differences in the ideal degree of cement dispersion, kyphoscolic Cobb angle 1 d and 3 months after operation and the recovery rate of vertebral body height between the two groups. The asymptomatic leakage rate of bone cement was 9.38%(3/32) in the unilateral approach group and 11.11%(4/36) in the bilateral approach group.

Conclusion

Both unilateral paravertebral approach and bilateral pedicle access percutaneous vertebroplasty can treat lumbar osteoporotic vertebral fractures quickly and effectively, and unilateral percutaneous vertebroplasty can relatively reduce the operation time and fluoroscopy times, bone cement consumption and bleeding volume.

Key words: Lumbar spine, Osteoporosis fractures, Unilateral, Lateral pedicle approach, Percutaneous vertebroplasty

Hongliang Chen, Kaijin Guo, Gang Duan, Feng Yuan, XiangYang Chen. Clinical observation of unilateral-beside approach PKP in treatment of lumbar OVCF[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2021, 07(03): 140-146.

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Figures/Tables 6

References 28

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组别	例数	男/女（例）	年龄（岁，±s）	BMI（kg/m²，±s）	骨密度T值（mg/cm³，±s）	骨折椎体分布情况（例）
组别	例数	男/女（例）	年龄（岁，±s）	BMI（kg/m²，±s）	骨密度T值（mg/cm³，±s）	L₁	L₂	L₃	L₄	L₅
单侧组	32	7/25	70±5	19.5±2.1	2.9±0.4	12	7	9	7	0
双侧组	36	9/27	72±7	20.2±1.8	3.0±0.5	15	8	6	6	3
统计值		χ²=0.299	t=1.267	t=0.169	t=0.743	χ²=0.585
P值		0.979	0.210	0.528	0.460	0.561

组别	例数	男/女（例）	年龄（岁，±s）	BMI（kg/m²，±s）	骨密度T值（mg/cm³，±s）	骨折椎体分布情况（例）
组别	例数	男/女（例）	年龄（岁，±s）	BMI（kg/m²，±s）	骨密度T值（mg/cm³，±s）	L₁	L₂	L₃	L₄	L₅
单侧组	32	7/25	70±5	19.5±2.1	2.9±0.4	12	7	9	7	0
双侧组	36	9/27	72±7	20.2±1.8	3.0±0.5	15	8	6	6	3
统计值		χ²=0.299	t=1.267	t=0.169	t=0.743	χ²=0.585
P值		0.979	0.210	0.528	0.460	0.561

组别	例数	手术时间（min）	术中透视数（次）	术中出血量（ml）	骨水泥注射量（ml）	住院天数（d）
单侧组	32	37±6	17±4	15±3	4.8±1.1	4.0±1.1
双侧组	36	51±8	26±5	23±5	5.7±1.4	4.8±1.2
t值		7.967	7.72	7.636	3.035	2.548
P值		<0.001	<0.001	<0.001	0.003	0.132

组别	例数	手术时间（min）	术中透视数（次）	术中出血量（ml）	骨水泥注射量（ml）	住院天数（d）
单侧组	32	37±6	17±4	15±3	4.8±1.1	4.0±1.1
双侧组	36	51±8	26±5	23±5	5.7±1.4	4.8±1.2
t值		7.967	7.72	7.636	3.035	2.548
P值		<0.001	<0.001	<0.001	0.003	0.132

组别	例数	后凸cob角（°，±s）			椎体前缘压缩程度（%，±s）			骨水泥理想分布率[例（%）]	骨水泥无症状渗漏率[例（%）]
组别	例数	术前	术后1 d	术后3个月	术前	术后1 d	术后3个月	骨水泥理想分布率[例（%）]	骨水泥无症状渗漏率[例（%）]
单侧组	32	37±5	9±3^*	10±3^*	37±9	15±6^*	15±6^*	27（84.38）	3（9.38）
双侧组	36	39±7	10±3^*	10±3^*	37±11	17±5^*	16±6^*	31（86.11）	4（11.11）
统计值		t=1.101	t=0.706	t=0.903	t=0.235	t=1.305	t=0.334	χ²=0.019	χ²=0.055
P值		0.275	0.481	0.369	0.815	0.196	0.735	0.887	0.814

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