Efficacy of unilateral percutaneous kyphoplasty combined with posterior medial branch block of the contralateral spinal nerve in the treatment of lumbar osteoporotic vertebral compression fracture in the elderly
Objective To compare the efficacy of unilateral percutaneous kyphoplasty(PKP)and unilateral PKP combined with posterior medial branch block of the contralateral spinal nerve in the treatment of lumbar osteoporotic vertebral compression fracture(OVCF)in the elderly.Methods A retrospective cohort study was conducted to analyze the clinical data of 161 aged patients with newly developed lumbar OVCF,admitted to Xi'an Central Hospital Affiliated to Xi'an Jiaotong University School of Medicine from January 2019 to January 2023,including 58 males and 103 females,aged 61-88[(72.9±6.3)years].All the patients were diagnosed with type Ⅱ compression fracture based on acute symptomatic osteoporotic thoracolumbar fracture classification(ASOTLF).Seventy-eight patients underwent unilateral PKP(PKP group),while the other 83 patients underwent unilateral PKP combined with posterior medial branch block of the contralateral spinal nerve(PKP+contralateral block group).The operation time,intraoperative blood loss,and length of hospital stay were recorded.Beck index of the injured vertebra,Cobb angle of lumbar lordosis,Roland-Morris disability(RMD)score,visual analogue scale(VAS),and Oswestry disability index(ODI)were evaluated before operation,at 1 day,1 week,1 month,3 months after operation,and at the last follow-up.The incidence of complications such as cement leakage was recorded as well.Results All the patients were followed up for 6-8 months[(6.7±0.6)months].There were no significant differences between the two groups in the operation time,intraoperative blood loss,or length of hospital stay(P＞0.05).The Beck index of the injured vertebra and Cobb angle of lumbar lordosis were not significantly different between the two groups before operation,at 1 day,1 week,1 month,3 months after operation,and at the last follow-up(P＞0.05).The RMD score of the injured vertebra,VAS score,and ODI were not significantly different between the two groups before operation(P＞0.05).At 1 day,1 week,1 month,3 months after operation,and at the last follow-up,the RMD scores in the PKP+contralateral block group were(11.23±1.05)points,(10.90±1.11)points,(10.10±1.06)points,(9.94±1.06)points,and(9.60±0.83)points respectively,which were all lower than(17.55±0.71)points,(15.78±0.86)points,(13.42±0.92)points,(10.67±0.78)points,and(9.78±0.72)points in the PKP group(P＜0.05 or 0.01);the VAS scores in the PKP+contralateral block group were(3.02±0.60)points,(2.96±0.55)points,(2.92±0.57)points,(2.88±0.61)points,and(2.70±0.51)points respectively,which were all lower than(3.60±0.57)points,(3.47±0.55)points,(3.32±0.46)points,(2.99±0.47)points,and(2.77±0.42)points in the PKP group(P＜0.05 or 0.01);the ODI values in the PKP+contralateral block group were 14.43±1.29,14.54±1.24,14.63±1.32,14.37±1.31,and 13.42±1.45 respectively,which were all lower than 16.72±1.64,16.09±1.49,14.82±1.53,14.74±1.46,and 13.69±1.75 in the PKP group(P＜0.05 or 0.01).The bone cement leakage rate was 12.0％(10/83)in the PKP+contralateral block group,similar to 11.5％(9/78)in the PKP group(P＞0.05).No other complications such as neurovascular injury,pulmonary embolism or adjacent vertebral fracture were found in either groups.Conclusion In the treatment of lumbar OVCF in the elderly,unilateral PKP combined with posterior medial branch block of the contralateral spinal nerve is similar to unilateral PKP in terms of the operation time,intraoperative blood loss,length of hospital stay,effectiveness of reduction,and incidence of complications,but it can achieve better pain relief and more satisfactory functional recovery.
NETL
NSTL
万方数据
