| Objective: To evaluate the clinical treatment efficacy of different approaches,extrapedicular approach and bipedicular approach of percutaneous vertebroplasty(PVP),to osteoporotic vertebral compression fractures of the upper and middle thoracic spine and to evaluate which one is more superior,which is to provide more reference basis for clinicians.Methods: The study enrolled 40 cases with the upper and middle thoracic spine osteoporotic compression fracture who were patients meeting the inclusion criteria in the First Affiliated Hospital of Hebei North University from 2018.10 to 2019.10.The 40 cases were through different approaches divided into Group A and Group B.Group A was treated with extrapedicular approach of PVP and Group B was treated with bipedicular approach of PVP.The patients in two groups underwent PVP surgery through different approaches,that is bone cement was injected into the affected vertebrae after percutaneous puncture.Statistical preoperative baseline data: age、gender,weight,bone mineral density(BMD)、distribution of vertebrae;observation indicators: the VAS score,ODI score,kyphosis angle(KA)of the compressive vertebral body,the compression rates of the anterior and middle parts of the diseased vertebrae before surgery,1 day after surgery,3months 、 6 months and 12 months after surgery;the volume of bone cement injection in two groups during the operation,the operation time,the postoperative bone cement leakage rate and complications were recorded in detail.The follow-up observation time in two groups was more than 12 months.The statistical software SPSS 20.0was used to make statistics and analyze the data results.Results: ⑴ In terms of age、gender、weight 、bone mineral density and distribution of vertebrae,there was no statistical significance in the baseline data in two groups(P>0.05);⑵ The operation time of group A was(34.7±3.4)min,and the operation time of group B was(46.2±4.2)min.There was a statistical difference between the two groups(P<0.05);⑶ The VAS score: There was a statistical difference one day after surgery,3months、6 months and 12 months after surgery in group A and group B(P<0.05),and there was no statistical difference within the two groups before and after the surgery(P>0.05);⑷ The ODI score: There was a statistical difference one day after surgery,3months、6 months and 12 months after surgery in group A and group B(P<0.05),and there was no statistical difference within the two groups before and after the surgery(P>0.05);⑸ The compression rate of the diseased vertebrae:(1)In terms of the compression rate of anterior parts of the diseased vertebrae,there was a statistical difference one day after surgery,3months 、 6months and 12 months after surgery in group A and group B(P<0.05),(2)In terms of the compression rate of anterior parts of the diseased vertebrae,there was a statistical difference one day after surgery,3months 、 6months and 12 months after surgery in group A and group B(P<0.05);⑹ kyphosis angle(KA)of the compressive vertebral body: There was a statistical difference one day after surgery,3months、6 months and 12 months after surgery in group A(P<0.05);There was a statistical difference one day after surgery,3months、6 months and 12 months after surgery in group B(P<0.05),there was no statistical difference within the two groups before and after the surgery(P>0.05);⑺ The volume of bone cement injection in group A was(2.7±0.63)ml,and the volume of bone cement injection in group B was(2.5±0.65)ml.There was no statistical significance between the two groups in terms of bone cement injection(t=1.21,P=0.23);⑻ The bone cement leakage rate of group A was 10%,and the bone cement leakage rate of group B was 15%.There was no statistical significance in the bone cement leakage rate between the two groups(X2=0.22,P=0.63);⑼ There was 1 case of vertebral pedicle rupture(no clinical symptoms)in group B,and 1 case of vertebral pedicle fracture with spinal cord injury,but no case in group A.There was no statistical difference between the two groups(X2=2.10,P=0.14);⑽ One case of secondary fracture of adjacent vertebral body in group A,and group B had 2 cases of adjacent vertebral body.Conclusion: The treatment of osteoporotic vertebral compression fractures of the upper and middle thoracic spine through extrapedicular approach of PVP can obtain clinical treatment efficacy,which can effectively relieve the pain and improve the patient quality of life,and the operation can be completed in a shorter time.At the same time,it has the advantage of less trauma.The clinical treatment efficacy is the same as bipedicular approach of PVP.Therefore,the PVP for the upper and middle thoracic spine osteoporotic vertebral compression fractures is safe feasible and effective. |
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