弯角穿刺针椎体成形技术治疗胸、腰椎骨质疏松性椎体压缩骨折

摘要

Objective To investigate the clinical effect of percutaneous curved vertebroplasty in the treatment of thoracolum?bar osteoporotic vertebral compression fractures (OVCFs). Methods All of 85 patients with single thoracolumbar vertebral OVCFs who met the admission criteria from January 2017 to July 2018 were divided into three groups according to the random dig?its table method. They were treated with percutaneous curved vertebroplasty, routine unipedicular PVP and routine bipedicular PVP respectively. There were 25 patients in the percutaneous curved vertebroplasty group, 6 males and 19 females; aged 56-80 years, with an average age of 70.6±9.7 years. Fracture vertebral body distribution:T10 2 cases,T11 4 cases,T12 3 cases, L1 9 cases, L2 3 cases, L3 1 case, L4 1 case and L5 2 cases. There were 32 patients in the routine unipedicular PVP group, 6 males and 26 fe? males; aged 58-75 years, with an average age of 69.5±9.3 years. Fracture vertebral body distribution: T10 2 cases, T11 4 cases, T12 5 cases, L1 11 cases, L2 6 cases, L3 1 case, L4 1 case and L5 2 cases. There were 28 patients in the routine bipedicular PVP group, 5 males and 23 females; aged 59-81 years, with an average age of 69.8±8.8 years. Fracture vertebral body distribution: T10 2 cases, T11 4 cases, T12 4 cases, L1 10 cases, L2 4 cases, L3 1 case, L4 1 case and L5 2 cases. The operation time, injected cement volume, in?traoperative blood loss were recorded and analyzed. Preoperative, postoperative 1 week and 3 months visual analogue scale scores and oswestry disability index were adopted to value the clinical improvements. Preoperative, postoperative 1 week and 3 months relative vertebral height and kyphosis correction, and the cement leakage rate were measured and analyzed. Results There was no significant difference in the data of gender, age, VAS scores, ODI and distribution of fracture vertebrae among the three groups (P>0.05), and the baseline data was comparable. The average VAS score in the percutaneous curved vertebroplasty group was 2.3±0.5 at 1 week after surgery, that of the routine unipedicular PVP group was 2.4±0.4 and that of the routine bipe?dicular PVP group was 2.4±0.4; the average ODI in the percutaneous curved vertebroplasty group was 19.8%±3.9%, that of the routine unipedicular PVP group was 20.0%±4.1% and that of the routine bipedicular PVP group was 19.9%±3.8%; they were lower than the preoperative data, which were statistically significant (P<0.001). The average relative vertebral height in the percutaneous curved vertebroplasty group was 48.99%±9.23% at 3 months after surgery, that of the routine unipedicular PVP group was 47.11%±10.12% and that of the routine bipedicular PVP group was 46.71%±11.16%; the average kyphosis cor?rection in the percutaneous curved vertebroplasty group was 6.21%±1.94%, that of the routine unipedicular PVP group was 5.22%±2.07% and that of the routine bipedicular PVP group was 5.97%±2.09%; there was 1 cement leakage case in the per?cutaneous curved vertebroplasty group; those of the routine unipedicular PVP group were 4 cases and those of the routine bipe?dicular PVP group were 6 cases; there was no significant difference among the three groups (P>0.05). Operation time 39.10± 2.00 min vs 38.70±1.70 min, injected cement volume 3.60±0.11 ml vs 3.50±0.13 ml and blood loss 5.10±0.30 ml vs 5.00±0.40 ml of the percutaneous curved vertebroplasty group and the routine unipedicular PVP group were less than those of the routine bipedicular PVP group, which were statistically significant (P<0.05). Conclution Percutaneous curved vertebroplasty could achieve satisfactory clinical outcomes for OVCFs, with advantages of less operation time, less blood loss, limited X?ray expo?sure, less injected cement volume, and more balanced augmentation for stabilization of the affected vertebrae and total verte?bral column.%目的 探讨弯角穿刺针椎体成形术(percutaneous vertebroplasty,PVP)治疗胸、腰椎骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCFs)的临床疗效.方法 2017年1月至2018年7月符合纳入标准的85例胸腰椎单椎体OVCFs患者,采用前瞻性随机对照(随机数字表法)的方法分为三组,即采用弯角穿刺PVP组、普通PVP单侧穿刺组和普通PVP双侧穿刺组.弯角穿刺PVP组25例,男6例,女19例;年龄56~80岁,平均(70.6±9.7)岁;骨折椎体分布:T102例、T114例、T123例、L19例、L23例、L31例、L41例,L52例.普通PVP单侧穿刺组32例,男6例,女26例;年龄58~75岁,平均(69.5±9.3)岁;骨折椎体分布:T102例、T114例、T125例、L111例、L26例、L31例、L41例、L52例.普通PVP双侧穿刺组28例,男5例,女23例;年龄59~81岁,平均(69.8±8.8)岁;骨折椎体分布:T102例、T114例、T124例、L110例、L24例、L31例、L41例、L52例.记录三组患者的手术时间、骨水泥注入量、术中出血量,术前、术后1周及3个月采用疼痛视觉模拟评分(visual an?alogue scale,VAS)及Oswestry功能障碍指数(Oswestry disability index,ODI)评价临床疗效,术前、术后1周及3个月测量病变椎体相对高度、局部Cobb角以及骨水泥渗漏率,并进行统计学分析.结果 三组患者的性别、年龄、VAS评分、ODI及骨折椎体分布等的差异均无统计学意义(P>0.05),基线资料具有可比性.术后1周VAS评分弯角穿刺PVP组平均为(2.3± 0.5)分,普通PVP单侧穿刺组为(2.4±0.4)分,普通PVP双侧穿刺组为(2.4±0.4)分;ODI弯角穿刺PVP组平均为19.8%± 3.9%,普通PVP单侧穿刺组为20.0%±4.1%,普通PVP双侧穿刺组为19.9%±3.8%;均较术前明显降低,差异均有统计学意义(P<0.001).术后3个月病椎相对高度弯角穿刺PVP组平均为48.99%±9.23%,普通PVP单侧穿刺组为47.11%±10.12%,普通PVP双侧穿刺组为分46.71%±11.16%;Cobb角恢复率弯角穿刺PVP组平均为6.21%±1.94%,普通PVP单侧穿刺组为5.22%±2.07%,普通PVP双侧穿刺组为5.97%±2.09%);骨水泥渗漏弯角穿刺PVP组发生1例,普通PVP单侧穿刺组4例;普通PVP双侧穿刺组6例;三组的差异均无统计学意义(P>0.05).弯角穿刺PVP组与普通PVP单侧穿刺组的手术时间[(39.10±2.00)min vs (38.70±1.70) min]、骨水泥注入量[(3.60±0.11)ml vs(3.50±0.13)ml]及术中出血量[(5.10±0.30)ml vs(5.00±0.40)ml]均较普通PVP双侧穿刺组减少,差异有统计学意义(P<0.05).结论 应用弯角椎体成形技术治疗OVCFs能取得理想的临床效果,并可减少手术时间、术中出血量、辐射剂量和骨水泥注入量,同时均匀强化靶椎体,增强骨折椎体及脊柱的稳定性.