经皮椎体成形术中低温骨水泥灌注技术改进前后疗效比较  

Effectiveness comparison of low-temperature bone cement perfusion before and after improvement in percutaneous vertebroplasty

作　　者：张洋[1] 龙浩[1] 肖杰[1] 邹伟[1] 周昌俊[1] 刘杰[1] 王国贤 ZHANG Yang;LONG Hao;XIAO Jie;ZOU Wei;ZHOU Changjun;LIU Jie;WANG Guoxian(Department of Spine Surgery,the Fourth People’s Hospital of Guiyang City,Guiyang Guizhou,550002,P.R.China)

机构地区：[1]贵阳市第四人民医院脊柱外科,贵阳550002

出　　处：《中国修复重建外科杂志》2020年第4期428-434,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：贵阳市科技计划项目(筑科合同[2019]9-11-10号)。

摘　　要：目的通过比较经皮椎体成形术(percutaneous vertebroplasty,PVP)中低温骨水泥灌注技术改进前后的疗效,探讨改进后技术的安全性和有效性。方法回顾分析2016年1月—2018年1月收治的符合选择标准的170例(184个椎体)骨质疏松性椎体压缩性骨折患者临床资料,均采用低温骨水泥灌注技术行PVP治疗。根据技术改进与否分为技术改进前组(A组,95例),采用保持骨水泥周围温度为0℃及平行穿刺术;技术改进后组(B组,75例),采用提高骨水泥周围温度或减少骨水泥在冰生理盐水中的时间及交叉穿刺术。两组患者性别、年龄、病程、骨密度T值、手术节段及术前椎体压缩率、疼痛视觉模拟评分(VAS)比较差异均无统计学意义(P>0.05)。术后即刻行CT检查,统计两组骨水泥渗漏率;比较两组骨水泥灌注量,椎体中骨水泥同时接触上下终板所占比例,术前、术后即刻及末次随访时计算两组椎体压缩率,并采用VAS评分评价疼痛缓解情况。结果两组均无切口感染、脊髓神经损伤、肺栓塞等并发症发生。A、B组骨水泥灌注量比较差异无统计学意义(t=0.175,P=0.861)。A组骨水泥同时接触上下终板有38个椎体(36.89%),B组有49个椎体(60.49%),两组差异有统计学意义(χ^2=10.132,P=0.001)。A组有19个椎体(18.45%)发生骨水泥渗漏,B组有6个椎体(7.41%),两组差异有统计学意义(χ^2=4.706,P=0.030)。两组患者均获随访,A、B组随访时间分别为(13.3±1.2)个月和(11.5±1.1)个月。两组术后即刻椎体压缩率均较术前显著减小(P<0.05);但A组末次随访时椎体压缩率与术前比较差异无统计学意义(P>0.05),较术后即刻显著增大(P<0.05),B组末次随访与术后即刻比较差异无统计学意义(P>0.05)。两组术后即刻VAS评分均较术前显著减小(P<0.05);但A组末次随访时VAS评分较术后即刻显著增大(P<0.05),B组无统计学意义(P>0.05)。两组间术后即刻VAS评分比较差异无统计学意义(t=0Objective To discuss the safety and effectiveness of the improved technique by comparing the effects of low temperature bone cement infusion before and after the improvement in the percutaneous vertebroplasty(PVP).Methods The clinical data of 170 patients(184 vertebrae)with osteoporotic vertebral compression fracture who met the selection criteria between January 2016 and January 2018 were retrospectively analyzed.All patients were treated with PVP by low-temperature bone cement perfusion technology.According to the technical improvement or not,the patients were divided into two groups:the group before the technical improvement(group A,95 cases)and the group after the technical improvement(group B,75 cases).In group A,the patients were treated by keeping the temperature of bone cement at 0℃and parallel puncture;in group B,the patients were treated by increasing the temperature of bone cement or reducing the time of bone cement in ice salt water and cross puncture.There was no significant difference in gender,age,disease duration,T value of bone mineral density,operative segment,and preoperative vertebral compression rate,visual analogue scale(VAS)score between the two groups(P>0.05).CT examination was performed immediately after operation,and the leakage rate of bone cement was calculated.The amount of bone cement perfusion and the proportion of bone cement in contact with the upper and lower endplates at the same time were compared between the two groups.The vertebral compression rate was calculated and the VAS score was used to evaluate the pain before operation,at immediate after operation,and last follow-up.Results There was no complication such as incision infection,spinal nerve injury,or pulmonary embolism in both groups.There was no significant difference in the amount of bone cement perfusion between groups A and B(t=0.175,P=0.861).There were 38 vertebral bodies(36.89%)in group A and 49 vertebral bodies(60.49%)in group B exposed to bone cement contacting with the upper and lower endplates at the same ti

关 键 词：经皮椎体成形术 骨质疏松性椎体压缩性骨折 低温骨水泥灌注 骨水泥渗漏 

分 类 号：R687.3[医药卫生—骨科学]