不同术式及不同入路对骨质疏松性椎体压缩骨折患者经皮椎体强化术后早期疗效的影响OA

Objective:To evaluate the effects of different surgical procedures and approaches on early postoperative outcomes of percutane-ous vertebral augmentation(PVA)in patients with osteoporotic vertebral compression fracture(OVCF).Methods:A total of 430 OVCF pa-tients treated with percutaneous vertebroplasty(PVP)or percutaneous kyphoplasty(PKP)were enrolled in the study.The patients were as-signed into either a PVP group or a PKP group according to the surgical procedure,and categorized into a unilateral approach group and a bilateral approach group based on the surgical approach.The visual analogue scale(VAS)score for low back pain,VAS score for percussion pain over the spinous process of the fractured vertebra,modified Oswestry disability index(ODI),and positive rate of the back pain-inducing test(BPIT)evaluated at 24 hours post-surgery were compared between PVP group and PKP group,as well as between unilateral approach group and bilateral approach group.Results:①Effects of different surgical procedures on early postoperative outcomes of PVA in OVCF pa-tients.Two hundred and seventy-two patients were enrolled in the PVP group,and 158 ones in the PKP group.No significant differences were observed between the two groups in the VAS score for low back pain,VAS score for percussion pain over the spinous process of the fractured vertebra,or modified ODI evaluated at 24 hours post-surgery(Z=-0.109,P=0.913;Z=-1.376,P=0.169;Z=-0.642,P=0.521),however,the positive rate of the BPIT evaluated at 24 hours post-surgery was significantly lower in PKP group compared to PVP group(χ2=20.152,P=0.000).②Effects of different surgical approaches on early postoperative outcomes of PVA in OVCF patients.A to-tal of 104 patients were enrolled in the unilateral approach group,and 326 ones in the bilateral approach group.There was a significant difference in the fracture time between the two groups(χ2=14.429,P=0.006),while,no significant differences were found between the two groups in the VAS score for low back pain,VAS score for percussion pain over the spinous process of the fractured vertebra,or positive rate of the BPIT evaluated at 24 hours post-surgery(Z=-0.228,P=0.819;Z=-1.589,P=0.112;χ2=0.172,P=0.679),however,the modified ODI evaluated at 24 hours post-surgery was lower in unilateral approach group compared to bilateral approach group(Z=-2.535,P=0.011).After adjusting for the fracture time in the regression analysis,the surgical approach had a significant effect on the modified ODI at 24 hours post-surgery,with the unilateral approach group showing a lower modified ODI at 24 hours post-surgery compared to the bilateral approach group(β=-6.636,95%CI(-11.129,-2.144),P=0.004).Conclusion:For patients with OVCF,PKP is superior to PVP in maintaining early postoperative vertebral stability and alleviating early postoperative dynamic pain,while the unilateral approach outperforms the bilateral approach in restoring early postoperative thoracolumbar function.