Clinical Effects Analysis Of Unilateral Pedicle Side Approach And Bilateral Pedicular Approach PKP In The Treatment Of OVCF

Objective:To study the clinical effects of the treatment of osteoporotic vertebral compression fractures(OVCF)by the unilateral pedicle side approach and bilateral pedicular approach PKP.To compare the difference of curative effect between the two surgical approaches and provide references for clinical work.Methods:Clinical data of 90 OVCF patients treated with PKP in our hospital from November 2016 to May 2018 were collected.The admission time of all patients was first sorted and then divided into two groups by random number table method.In the unilateral pedicle side approach group(observation group),45 patients included vertebral body in 53 cases,11 males with vertebral body in 13 cases and 34 females vertebral body in 40 cases.The age ranged from 55 to 92,with an average of(71.71±8.43)years old.Fracture vertebral segements were T6 vertebral body in 1 case,T7 vertebral body in 1 case,T8 vertebral body in 2 cases,T9 vertebral body in 6 cases,T10 vertebral body in 1 case,T11 vertebral body in 3 case,T12 vertebral body in 8 cases,L1 vertebral body in 15 cases,L2 vertebral body in 7 cases,L3 vertebral body in 3 cases,L4 vertebral body in 5 cases,and L5 vertebral body in 1 case.In the bilateral pedicular approach group(control group),45 patients included vertebral body in 49 cases,8 males with vertebral body in 10 cases,and 37 females with vertebral body in 39 cases.The age ranged from 57 to 87,with an average of(70.31±7.40)years old.Fracture vertebral segements were T7 vertebral body in 1 case,T9 vertebral body in 1 case,T10 vertebral body in 1 case,T11 vertebral body in 3 cases,T12 vertebral body in 14 cases,L1 vertebral body in 13 case,L2 vertebral body in 8 cases,L3 vertebral body in 5 cases,L4 vertebral body in 3 cases.Perioperative indicators were compared between the two groups: the length of hospital stay,operation time,intraoperative blood loss,intraoperative radioscopy times,and injection volume of bone cement,and statistical analysis was perfoemed.The subjective scores of the two groups were compared: VAS score and Oswestry disability index(ODI score)preoperative,at 72 hours after operation,and at 6 months after operation,and statistical analysis was performed.The objective measures of imaging were compared between the two groups: preoperative,at 72 hours after operation and at 6 months after operation of the anterior vertebral height(AVH)and the kyphosis Cobb angle,and statistical analysis was performed.At the same time,the complications of the two groups were recorded.The statistical software of SPSS23.0 was used,where P<0.05 indicated that the difference was statistically significant.Results:Patients in both groups successfully completed the surgery and were followed up for a period of 6 months.There were no significant differences in gender,age,and fracture vertebral segments between the two groups(p>0.05).There was no significant difference in the length of hospital stay between the two groups(p>0.05).There were statistically significant differences between the two groups in terms of operation time,intraoperative blood loss,intraoperative radioscopy times and injection volume of bone cement(p < 0.01).The VAS score,ODI score,AVH,and Cobb angle of the two groups at 72 hours,6months after operation were significantly different from those before operation(p<0.01).But no significant difference was found between the two groups(p>0.05).In the observation group,there were 1 case of bone cement leakage occured in front of the vertebral body and intervertebral space respectively.In the control group,there were 5 cases of bone cement leakage occured:1 case in front of the vertebral body,1 case behide the vertebral body,1 case intervertebral space,and 2 cases lateral vertebral body.All of cases of bone cement leakage had no clinical symptoms.In the observation group and the control group,1 case and 2 cases of adjacent vertebral body refracture occurred respectively.The follow-up status was good after reoperation.Conclusions:When it comes to the treatment of OVCF,the unilateral pedicle side approach and bilateral pedicular approach PKP could both alleviate pain,restore vertebral body height,correct kyphosis,and improve quality of life and achieve similar clinical results.The unilateral pedicle side approach PKP was more advantages in reducing the operation time,intraoperative blood loss,intraoperative radioscopy times,and injection volume of bone cement.OVCF is essentially a pathological fracture caused by osteoporosis.No matter which surgical approach is chosen,the postoperative anti-osteoporosis treatment should be strict and standard.