Objective: To compare the short-term effectiveness and safety of unipedicular versus bipedicular percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF) with posterior wall broken.
Methods: The clinical data of 68 patients with OVCF with posterior wall broken and without posterior ligament complex injury and spinal cord nerve injury between June 2013 and December 2018 were retrospectively analyzed. According to the different operative approaches, the patients were divided into two groups: group A (36 cases received PKP via bilateral pedicle puncture) and group B (32 cases received PKP via unilateral pedicle paracentesis). There was no significant difference between the two groups in gender, age, fracture vertebra distribution, time from injury to operation, preoperative pain visual analogue scale (VAS) score, Oswestry disability index (ODI), and height of injured vertebra ( P>0.05). The operation time, intraoperative fluoroscopy times, and bone cement volume were recorded and compared between the two groups. The VAS score and ODI score were used to evaluate the effectiveness before operation, at 1 day and 6 months after operation; the height of injured vertebra was measured on the lateral X-ray film, and the recovery height of injured vertebra at 1 day after operation and the loss height of injured vertebra at 6 months after operation were calculated; the intraoperative and postoperative complications of the two groups were recorded.
Results: The operation time, intraoperative fluoroscopy times, and bone cement volume of group B were significantly less than those of group A ( P<0.05). All patients were followed up 10-35 months, with an average of 18 months. During the operation, there were 2 cases (5.56%) of cement leakage in group A and 9 cases (28.13%) in group B, showing significant difference ( χ 2=4.808, P=0.028). There was no adverse reactions of bone cement, iatrogenic spinal cord injury, infection of puncture port, or other complications in the two groups. During the follow-up period, there were 3 cases (8.3%) of adjacent vertebral fractures in group A and 2 cases (6.3%) in group B, showing no significant difference between the two groups ( χ 2=0.027, P=0.869). The height of injured vertebra of the two groups at 1 day and 6 months after operation were significantly improved when compared with preoperative ones ( P<0.05). There was no significant difference in the height of injured vertebrae and the recovery height of injured vertebra at 1 day after operation between the two groups ( P>0.05). However, at 6 months after operation, the height of injured vertebra in group B was significantly lower than that in group A ( P<0.05), and the loss height of injured vertebra in group B was significantly higher than that in group A ( P<0.05). The VAS score and ODI score at 1 day and 6 months after operation were significantly improved when compared with preoperative ones in both groups ( P<0.05), but there was no significant difference between the two groups ( P>0.05).
Conclusion: Both bipedicular and unipedicular PKP can obtain satisfactory effectiveness for the treatment of OVCF with posterior wall broken, but the former may have advantages of lower cement leakage rate and less height loss.
目的: 比较双侧与单侧入路经皮椎体后凸成形术（percutaneous kyphoplasty，PKP）治疗伴后壁破损的骨质疏松性椎体压缩骨折（osteoporotic vertebral compression fracture，OVCF）的近期疗效。.
方法: 回顾分析 2013 年 6 月—2018 年 12 月收治的 68 例无后方韧带复合体损伤、无脊髓神经损伤症状的伴后壁破损的 OVCF 患者临床资料。根据手术入路不同分为 A 组（行双侧椎弓根穿刺入路 PKP 治疗，36 例）和 B 组（行单侧椎弓根旁穿刺入路 PKP 治疗，32 例）。两组患者性别、年龄、骨折椎分布、受伤至手术时间及术前疼痛视觉模拟评分（VAS）、Oswestry 功能障碍指数（ODI）、伤椎椎体高度比较，差异均无统计学意义（ P>0.05）。记录并比较两组患者手术时间、术中透视次数、骨水泥注入量。术前、术后 1 d 及术后 6 个月，采用 VAS 评分和 ODI 评分评价疗效；于侧位 X 线片上测量伤椎椎体高度，计算术后 1 d 伤椎椎体恢复高度及术后 6 个月丢失高度；记录两组患者术中、术后并发症。.
结果: B 组患者手术时间、术中透视次数、骨水泥注入量均显著少于 A 组（ P<0.05）。两组患者均获随访，随访时间 10～35 个月，平均 18 个月。术中 A 组发生骨水泥渗漏 2 例（5.56%），B 组 9 例（28.13%），比较差异有统计学意义（ χ 2=4.808， P=0.028），两组患者术中、术后均未出现骨水泥不良反应、医源性脊髓神经损伤、穿刺口感染等并发症。随访期间 A 组发生相邻椎体骨折 3 例（8.3%），B 组 2 例（6.3%），两组差异无统计学意义（ χ 2=0.027， P=0.869）。两组术后 1 d 及 6 个月伤椎椎体高度均较术前显著增加（ P<0.05）；两组术后 1 d 伤椎椎体高度及伤椎椎体恢复高度比较差异均无统计学意义（ P>0.05）；术后 6 个月 B 组伤椎椎体高度显著低于 A 组，伤椎椎体丢失高度显著大于 A 组，差异均有统计学意义（ P<0.05）。两组患者术后 1 d 及 6 个月 VAS 评分和 ODI 评分均较术前显著改善（ P<0.05）；术后 1 d 及 6 个月间比较差异均无统计学意义（ P>0.05）。两组间术后各时间点 VAS 评分和 ODI 评分比较差异均无统计学意义（ P>0.05）。.
结论: 双侧与单侧入路 PKP 治疗伴后壁破损的 OVCF 均可获得良好的临床疗效，但前者骨水泥渗漏率更低，且近中期随访椎体高度丢失更少。.
Keywords: Osteoporotic vertebral compression fracture; percutaneous kyphoplasty; surgical approach.