Department of Clinic of Spine Center, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China.
Shanghai Weiyu High School, Shanghai, 200231, China.
J Orthop Surg Res. 2023 Nov 22;18(1):887. doi: 10.1186/s13018-023-04368-2.
To assess the safety and efficacy of the extra-facet puncture technique applied in unilateral percutaneous vertebroplasty (PVP) for treating osteoporotic vertebral compression fractures.
Demographics (age, gender, body mass index and underlying diseases) were recorded for analyzing. Visual analog scale (VAS) and Oswestry Disability Index (ODI) scores as well as their corresponding minimal clinically important difference (MCID) were used to evaluate clinical outcomes. The segmental kyphotic angle, the vertebral compression ratio and bone cement distribution pattern were evaluated by the plain radiographs. The facet joint violation (FJV) was defined by the postoperative computed tomography scan. Binary logistic regression analysis was performed to investigate relationships between multiple risk factors and residual back pain.
VAS and ODI scores in both traditional puncture group and extra-facet puncture group were significantly decreased after PVP surgery (p < 0.05). However, no significant difference was observed between the two groups according to VAS and ODI scores. The proportion of patients achieving MCID of VAS and ODI scores was higher in extra-facet puncture group as compared to traditional puncture group within a month (p < 0.05). Finally, multivariate logistic regression analysis showed that FJV (odds ratio 16.38, p < 0.001) and unilateral bone cement distribution (OR 5.576, p = 0.020) were significant predictors of residual back pain after PVP surgery.
Extra-facet puncture percutaneous vertebroplasty can decrease the risk of FJV and it also has the advantage of more satisfied bone cement distribution.
评估在单侧经皮椎体成形术（PVP）中应用小关节突外穿刺技术治疗骨质疏松性椎体压缩性骨折的安全性和有效性。
记录患者的一般资料（年龄、性别、体重指数和基础疾病），采用视觉模拟评分（VAS）和 Oswestry 功能障碍指数（ODI）评分及其相应的最小临床重要差异（MCID）评估临床疗效。通过 X 线片评估节段后凸角、椎体压缩比和骨水泥分布模式。术后行 CT 扫描判断小关节突破坏（FJV）。采用二元逻辑回归分析探讨多个危险因素与残余腰痛之间的关系。
PVP 手术后，传统穿刺组和小关节突外穿刺组的 VAS 和 ODI 评分均显著降低（p<0.05）。但两组间 VAS 和 ODI 评分差异无统计学意义。小关节突外穿刺组在术后 1 个月内达到 VAS 和 ODI 评分 MCID 的患者比例明显高于传统穿刺组（p<0.05）。最后，多因素逻辑回归分析显示，FJV（比值比 16.38，p<0.001）和单侧骨水泥分布（OR 5.576，p=0.020）是 PVP 术后残余腰痛的显著预测因素。
小关节突外穿刺经皮椎体成形术可降低 FJV 的发生风险，且具有更满意的骨水泥分布优势。
