Efficacy comparison between unilateral and bilateral percutaneous kyphoplasty for thoracolumbar osteoporotic vertebral compression fractures
10.3760/cma.j.issn.1001-8050.2019.12.002
- VernacularTitle: 单双侧经皮椎体后凸成形术治疗胸腰段骨质疏松性椎体压缩骨折的疗效比较
- Author:
Xiaobin YANG
1
;
Dingjun HAO
1
;
Yuan HE
2
;
Lingbo KONG
1
;
Zhen ZHANG
1
;
Ke ZHANG
1
;
Liang YAN
1
;
Zhongkai LIU
1
;
Hua HUI
1
;
Baorong HE
1
Author Information
1. Department of Orthopedics, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an 710054, China
2. Department of Orthopedics, Xi' an No. 5 Hospital, Xi'an 710082, China
- Publication Type:Journal Article
- Keywords:
Osteoporotic fractures;
Spinal fractures;
Percutaneous kyphoplasty
- From:
Chinese Journal of Trauma
2019;35(12):1060-1067
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the efficacy of unilateral and bilateral percutaneous kyphoplasty (PKP) for thoracolumbar osteoporotic vertebral compression fractures (OVCFs).
Methods:A retrospective case control study was conducted to analyze the clinical data of 234 OVCFs patients admitted to Honghui Hospital affiliated to Xi'an Jiaotong University Medical College from June 2014 to January 2016. There were 95 males and 139 females, aged 60-89 years, with an average age of 68.3 years. The fractured segments included T11 in 45 patients, T12 in 65 patients, L1 in 72 patients, and L2 in 52 patients. A total of 116 patients were treated with PKP through unilateral puncture of transverse process and superior articular process (unilateral group), and 118 patients were treated with PKP through bilateral puncture of Magerl (bilateral group). The operation time, radiation exposure, bone cement injection and leakage were compared between the two groups. Visual analogue scale (VAS) and Oswestry dysfunction index (ODI) were used to evaluate the clinical efficacy and life quality improvement. The distribution of bone cement was observed by CT. The complications were recorded.
Results:All patients were followed up for 25-36 months, with an average of 27 months. The operation time of unilateral group [(19.6±5.3)minutes] was significantly shorter than that of bilateral group [(35.6±8.9)minutes]; the radiation exposure [(0.65±0.22)mSv] was lower than that of bilateral group [(1.69±0.58)mSv]; the bone cement injection [(5.3±0.8)ml] was less than that of bilateral group [(6.5±1.3)ml] (P<0.05). The postoperative X-ray showed that 10 patients (8.6%) in the unilateral group and 22 patients (18.6%) in the bilateral group (P<0.05) were found with bone segment leakage, although without clinical symptoms. The postoperative VAS and ODI of the two groups were significantly improved than before operation (P<0.01), and there was no significant difference between the two groups (P>0.05). Bone cement was mainly distributed in the front and middle of the vertebral body (A2, B1, C2, D1) in the unilateral group and in the front 2/3 of the vertebral body (A, B, C, D) in the bilateral group. There were in total 10 patients with cerebrospinal fluid during intraoperative puncture, including two patients in the unilateral group and eight patients in the bilateral group (P>0.05). The puncture direction was adjusted during the operation, and there was no neurological damage after the operation. There were 16 patients with local pain caused by small joint injury, including two patients in unilateral group and 14 patients in bilateral group (P<0.05). The pain was relieved one month after physical treatment. A total of 30 patients had vertebral fracture again, including 18 in unilateral group and 12 in bilateral group (P>0.05), all of whom were treated with PKP again.
Conclusion:Compared with Magerl bilateral approach, PKP for OVCFs has the advantages of shorter operation time, less radiation exposure, low leakage rate of bone cement and good distribution of bone cement.
