Title : Comparative analysis of the clinical efficacy of unilateral and bilateral PKP in the treatment of elderly patients with OVCF and its effect on patients' stress response
Abstract:
Background: Osteoporotic Vertebral Compression Fracture (OVCF) is a common clinical orthopedic disease in the elderly. Percutaneous vertebral Kyphoplasty (PKP) is a common surgical treatment, which is less invasive and favorable for postoperative recovery, but the efficacy of unilateral versus bilateral needs to be further explored. The aim of this study was to investigate the effects of unilateral versus bilateral PKP on the surgical outcomes of elderly patients with OVCF), life stress response, and to provide a reference for the treatment of elderly OVCF patients.
Methods: We retrospectively analyzed 80 cases of elderly OVCF patients hospitalized in the Department of Spine of our hospital from January 2022 to January 2023, 33 males and 47 females, aged 65-91 years old, with a disease duration of 1-9 d. A total of 103 vertebrae were treated, of which 39 cases of 52 vertebrae were treated in the group of 39 cases of unilateral PKP surgery (the unilateral group), and 41 cases of 51 vertebrae were treated in the group of 41 cases of bilateral PKP surgery (the bilateral group). All patients were followed up for at least 1 year, and the operation time, Visual Analog Score (VAS) of pain, height of the anterior margin of the vertebral body of the two groups in the preoperative period, postoperative period, and 1 year postoperative period were observed and compared, and the emergency response of the two groups was compared.
Results: The operation time of the unilateral group was (30.7±4.8) min, which was significantly lower than that of the bilateral group (48.2±7.3) min, and the differences were statistically significant (P<0.05). The VAS scores in the unilateral group were 7.8±0.4, 1.8±0.2, and 2.3±0.4 in the preoperative, postoperative, and 1-year postoperative periods, respectively, and the VAS scores in the bilateral group were 7.5±0.5, 2.2±0.2, and 2.1±0.2 in the preoperative, postoperative, and 1-year postoperative periods, respectively. The comparison was statistically significant (P<0.05). In the unilateral group, the vertebral body heights were (17.8±2.9) mm, (24.8±1.9) mm, and (23.4±2.8) mm in the preoperative, postoperative, and 1-year postoperative periods, respectively; and the vertebral body heights were (17.1±2.3) mm, (23.9±2.1) mm, and (21.2±2.2) mm in the bilateral group in the preoperative, postoperative, and 1-year postoperative periods, respectively., the vertebral body height of the unilateral group was higher than that of the bilateral, and the comparison of the data between the two groups was statistically significant (P<0.05). Postoperative Norepinephrine (NE), Epinephrine (E), and Cortisol (Cor) were elevated in both groups, but the unilateral group was lower than the bilateral group (P<0.05).
Conclusion: Unilateral and bilateral puncture PKP procedures have similar efficacy in the treatment of elderly patients with OVCF, but unilateral puncture PKP has the advantages of less trauma, shorter operation time, less radiation exposure, and less risk.
Keywords: Elderly OVCF Patients; Unilateral PKP; Bilateral PKP; Clinical Efficacy; Stress Reaction.
