经横突上缘椎弓根外侧入路单侧PKP治疗伴椎弓根狭窄骨质疏松性腰椎骨折

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Abstract

Objective To compare the clinical efficacy of extrapedicular unilateral percutaneous kyphoplasty(PKP) via the upper edge of the transverse process with that of traditional pedicle approach for the treatment of type II osteoporotic vertebral compression fracture with vertebral pedicle stenosis in the upper lumbar spine.Methods A prospective study was performed on the patients with II osteoporotic vertebral compression fractures of upper lumbar with pedicle stenosis treated from December 2020 to December 2021.According to random number table，the patients were divided into group A (treated with extrapedicular unilateral PKP via the upper edge of transverse process approach，68 cases) and group B (treated with unilateral PKP via transpedicle approach，67 cases).There were 25 males and 43 females in group A，aged from 60 to 89 years，with an average age of (70.40±6.95) years.In group B，there were 21 males and 46 females，aged from 60 to 85 years，with an average age of (73.02±8.51) years.The operation time，fluoroscopy frequency，bone cement injection volume，and bone cement dispersion were recorded.And the visual analogue scale(VAS)，Oswestry disability index(ODI) score，anterior height(AH)，and kyphotic angle(KA) 〖JP2〗of the injured vertebrae in each group were compared before and after surgery.Results All patients completed surgery successfully，41 patients lost follow-up due to irregular follow-up or incomplete imaging data，and 94 patients completed final follow-up for 11~14 months，with an average of (12.53±0.84) months.Three patients in group B developed compression fractures of the adjacent vertebrae.None of the patients had intraoperative infection，pulmonary embolism and other complications.VAS and ODI scores in 2 groups were significantly improved after surgery compared with before surgery，and the difference between 2 groups was statistically significant (P＜0.05).The AH and KA of the injured vertebrae in both groups were significantly improved at 1 day after operation，and the AH and KA of the injured vertebrae in group A were (22.12±0.58) mm and (14.32±0.40) °，which were better than those in group B (21.57±0.65) mm and (14.49±0.34)°，the differences were statistically significant (P＜0.05).The bone cement injection and the contralor distribution rate of bone cement in group A were (6.45±0.35) mL and (58.10±4.11)%，respectively，which were better than those in group B (5.29±0.48) mL and (25.82±3.92)%.Conclusion Compared with the traditional transpedicle approach，the extrapedicle approach via the upper edge of the transverse process has little difference in early postoperative imaging，however，it has significant effect on improving the degree of bone cement diffusion distribution on the contralateral side of the vertebral body and improving early postoperative pain while taking into account surgical safety.

Key words： percutaneous kyphoplasty osteoporotic fracture vertebral fracture pedicle stenosis

Corresponding Authors: Hao Dingjun

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	Chai Xin
	Yang Junsong
	Xu Hui
	Liu Tuanjiang
	Hao Dingjun

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Chai Xin,Yang Junsong,Xu Hui, et al. Extrapedicular Unilateral Percutaneous Vertebroplasty Via the Upper Edge of the Transverse Process for Lumbar Osteoporotic Vertebral Compression Fractures With Pedicle Stenosis[J]. sygkzz, 2023, 29(4): 296-.

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http://www.sygkzz.com/EN/ OR http://www.sygkzz.com/EN/Y2023/V29/I4/296

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