Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
World Neurosurg. 2022 Oct;166:e99-e108. doi: 10.1016/j.wneu.2022.06.115. Epub 2022 Jun 30.
Few researchers have verified the clinical efficacy and safety of the modified unilateral extrapedicular approach (mUEP) applied to the percutaneous kyphoplasty (PKP) in comparative studies with other puncture techniques. Compared with the bilateral transpedicular approach (BTP), whether mUEP PKP is a preferred treatment for lumbar osteoporotic vertebral compression fracture (OVCF) remains unclear.
Patients treated by PKP for single-level lumbar OVCF in our institution from September 2019 to December 2020 were retrospectively enrolled. Patients were grouped according to the puncture techniques. Clinical and radiologic outcomes were evaluated preoperatively, postoperatively, and at follow-up. The clinical evaluation was performed by using visual analog scale for pain relief and Oswestry Disability Index for health status. Radiologic measurements contained anterior vertebral height, kyphotic angle, and bone cement distribution.
In total, 76 patients with a mean follow-up duration of 16.6 months were enrolled, including 34 patients in the mUEP PK group and 42 patients in the BTP PKP group. In the mUEP group, operation time, fluoroscopy times, and injected cement volume were significantly less than that in the BTP group (P < 0.01). Both visual analog scale and Oswestry Disability Index scores of all patients decreased significantly after surgery (P < 0.01), with no significant differences between the 2 groups at each follow-up. Both mUEP PKP and BTP PKP showed significant anterior height restoration and kyphotic angle correction (P < 0.01), with no significant differences between the 2 groups at each follow-up. Meanwhile, the mUEP PKP reduced the incidence of intraspinal cement leakage (P < 0.05), and no facet joint violation was found in mUEP PKP.
mUEP PKP could be clinically and radiographically equivalent to BTP PKP. However, it has advantages in reducing operation time and fluoroscopy times, lowering the risk of intraspinal cement leakage, and preventing the presence of facet joint violation. Compared with BTP PKP, the mUEP PKP seems to be an effective and alternative puncture technique for the treatment of lumbar OVCF after appropriate patient selection.
很少有研究人员在与其他穿刺技术的对比研究中验证改良单侧经皮椎弓根外入路（mUEP）在经皮椎体后凸成形术（PKP）中的临床疗效和安全性。与双侧经皮椎弓根入路（BTP）相比，mUEP PKP 是否是治疗腰椎骨质疏松性椎体压缩性骨折（OVCF）的首选方法尚不清楚。
回顾性纳入 2019 年 9 月至 2020 年 12 月在我院接受单节段腰椎 OVCF 行 PKP 治疗的患者。根据穿刺技术将患者分组。术前、术后和随访时评估临床和影像学结果。临床评估采用疼痛缓解的视觉模拟评分和健康状况的 Oswestry 功能障碍指数。影像学测量包括椎体前缘高度、后凸角和骨水泥分布。
共纳入 76 例患者，平均随访时间为 16.6 个月，其中 mUEP PKP 组 34 例，BTP PKP 组 42 例。mUEP 组的手术时间、透视次数和注入的水泥量明显少于 BTP 组（P < 0.01）。所有患者的视觉模拟评分和 Oswestry 功能障碍指数评分均在术后显著降低（P < 0.01），但在每个随访时间点两组之间均无统计学差异。mUEP PKP 和 BTP PKP 均显示出明显的前柱高度恢复和后凸角矫正（P < 0.01），但在每个随访时间点两组之间均无统计学差异。同时，mUEP PKP 降低了椎管内水泥渗漏的发生率（P < 0.05），且 mUEP PKP 未发现关节突关节侵犯。
mUEP PKP 在临床和影像学上可与 BTP PKP 相媲美。然而，它在缩短手术时间和透视时间、降低椎管内水泥渗漏风险、防止关节突关节侵犯方面具有优势。与 BTP PKP 相比，mUEP PKP 在适当的患者选择后似乎是治疗腰椎 OVCF 的一种有效且可替代的穿刺技术。
