The Curative Of Unilateral And Bilateral Percutaneous Kyphoplasty In The Treatment Of Osteoporotic Vertebral Compression Fractures

Objective: To comparetively study the clinical curative of unilateral and bilateralpercutaneous kyphoplasty in the treatment of osteoporotic vertebral fractures.Methods: To retrospectively analysis62cases of surgical treatment of osteoporoticvertebral compression fractures from September2010to2012at Yan’an UniversityAffiliated Hospital Orthopedics. All patients were divided into two groups.Theunilateral approach group of32patients (40vertebrae body) included4male and28female with an average age of72.8(range54to88years old).The bilateral approachgroup of30patients (38vertebrae body) comprised3male and27female with the meanage of73.6(range from54to88years old). Under the guidance of “C”–armmonitoring,all patients were successfully completed percutaneous surgery and obtainedthe review and follow-up. Operative time,frequency of X-ray,injection rate of bonecement were observed. Visual Analogue Scale (VAS),vertebral kyphosis (Cobb),disability index (ODI) and the clinical efficicacy were measured pre-and postoperation.Results: All patients were operated successfully completed. The mean operativetime was (54.6±16.2) min and (92.4±14.2) min for bilateral;the X-ray fluoroscopy timeswere (29.4±2.6) and (48.2±2.8) times for bilateral;the mean volume of cement was(3.8±1.5) ml and（5.2±1.8）ml for unilateral and bilateral groups respectively. Thedifference between these two groups were statistically significantly (P <0.05).The meanVAS pain score of unilateral group decreased significantly from (8.2±2.6) pointspreoperatively to (2.6±1.8) points one day after postoperatively and (2.8±2.1) points sixmonths later at final follow-up,the mean VAS pain score of bilateral group decreasedsignificantly from (8.1±2.4) points preoperatively to (2.5±1.7) points one day afterpostoperatively and (2.7±1.6) points six months later,no significant differrnce was foundbetween two groups(P>0.05). The mean cobb’s angle of unilateral group rectifieddistinctly from (33o±8.2o) preoperatively to (21o±6.2o) one day after postoperatively and (22o±6.8o) six months later; the mean cobb’s angle of bilateral group decreased from(34o±8.1o) preoperatively to (20o±6.3o) one day after postoperatively and (21o±6.9o) sixmonths later. There was statistically significant compared to each group betweenpreoperative and postoperative (P<0.05); VAS scores，ODI and the Cobb’s angle betweenthe two groups in the same periods had no difference statistical significance (P>0.05).The unilateral group VAS improvement rate and efficacy average respectivelywas(68.3±12.6)%,93.8%;bilateral group VAS efficiency improvement rate and efficacywere averaged improvement rate and efficacy average respectively was(69.1±10.8)%,93.3%, the improvement of the VAS rate and efficiency were no statistical difference(p>0.05). Disability Index ODI: unilateral group from (70.2±10.2)%pre–operative to(36.2±14.2)%postoperative one day,and six months later average was(37.4±13.6)%;bilateral group from(70.8±11.1)%pre–operative to (36.4±13.3)%postoperative oneday,and six months later average was(37.8±14.2)%.62patients with surgically lumbar thepain of the back were Ease to varying degrees, the painful still obviously with two casesof patients in both two groups.There were4cases occurred cement leakage in unilateraland three cases of cement leakage in bilateral,but no neurological symptoms;all thepatients without pulmonary embolism and other complications.Conclusion:The vertebral stiffness,kyphosis angle, disability index recovery andpainful relief were nearly the same after treated by PKP in both the single and bilateralgroups,both groups achieved satisfactory clinical results, PKP was a kind of relativelysimple operations, safety and effective in a minimally invasive surgical techniques, butunilateral approach PKP with shorter operative time,less X-ray fluoroscopy times, withless bone cement and etc, it was recommended to application in the clinical treatment.