改良交叉穿刺椎体成形术治疗骨质疏松性椎体压缩骨折的临床效果分析  

Analysis of clinical efficacy of modified cross-puncture vertebroplasty in the treatment of osteoporotic vertebral compression fracture

作　　者：李志鲲 李一凡[1] 王奕[1] 于荣华[1] 张向阳[1] 朱晓东[1] 徐炜[1] LI Zhi-kun;LI Yi-fan;WANG Yi;YU Rong-hua;ZHANG Xiang-yang;ZHU Xiao-dong;XU Wei(Department of Orthopedics,Tongren Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200336,China)

机构地区：[1]上海交通大学医学院附属同仁医院骨科,上海200336

出　　处：《上海交通大学学报（医学版）》2020年第7期915-922,共8页Journal of Shanghai Jiao tong University:Medical Science

基　　金：国家自然科学基金青年科学基金(81903039);上海市青年科技英才扬帆计划(19YF1444500);上海市卫生计生系统优秀青年医学人才培养计划(2018YQ46);上海市长宁区科学技术委员会科研课题(CNKW2017Y07,CNKW2018Y10);上海市长宁区卫生健康委员会科研课题(20164Y003,20194Y008);上海市第六人民医院医疗集团课题(ly201802,ly201903);上海交通大学医工交叉研究基金(YG2017MS66,YG2016MS68);上海市卫生和计划生育委员会课题(201640233)。

摘　　要：目的·对比交叉穿刺技术与传统穿刺技术治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)的临床效果。方法·选择使用经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗的OVCF患者为研究对象,根据穿刺方法将患者分为交叉穿刺组和传统穿刺组,每组70例。于术前及术后不同时期比较2组患者的临床资料、影像学参数、疼痛评分、功能障碍评分、总体满意度及相关并发症,并评估2组的临床疗效。结果·与传统穿刺组对比,交叉穿刺组患者的楔形角在术后6、12个月降低(均P=0.000),而前缘高度增加(P=0.012,P=0.000)。在随访中,2组患者的疼痛评分及功能障碍评分间差异无统计学意义;与传统穿刺组对比,交叉穿刺组患者的优、良等级(奥多姆标准)占比较高(P=0.000,P=0.003),椎体塌陷、后凸畸形及椎管狭窄的发生率较低(P=0.000,P=0.002,P=0.031)。结论·交叉穿刺术后6、12个月,患者的楔形角及椎体前缘高度的随访变化相比传统穿刺技术变化更小,即更为稳定,椎体塌陷发生率更低,总体疗效满意度较高。Objective·To compare the clinical efficacy of cross puncture technique with traditional puncture technique in the treatment of osteoporotic vertebral compression fracture(OVCF).Methods·Patients with OVCF treated with percutaneous vertebroplasty(PVP)were selected.According to the puncture method,the patients were divided into cross puncture group and traditional puncture group,with 70 cases in each group.The clinical data,imaging parameters,pain score,dysfunction score,overall satisfaction and related complications of the two groups were compared before and after operation,and the clinical efficacy of the two groups was evaluated.Results·Compared with the traditional puncture group,the wedge angle in the cross puncture group decreased at 6 and 12 months after operation(both P=0.000),while the leading edge height increased(P=0.012,P=0.000).During the follow-up,there was no significant difference in pain score and dysfunction score between the two groups.Compared with the traditional puncture group,the proportion of the excellent and great grades(Odom standard)of patients in the cross puncture group was higher(P=0.000,P=0.003),and the incidence of vertebral collapse,kyphosis deformity and spinal stenosis were lower(P=0.000,P=0.002,P=0.031).Conclusion·At 6 and 12 months after operation of cross puncture PVP,the follow-up changes of wedge angle and leading edge height of vertebral body were smaller than those of traditional puncture technique,that is,more stable.The incidence of vertebral collapse was lower,and the overall satisfaction of the curative effect was higher.

关 键 词：交叉穿刺 椎体成形术 椎体塌陷 楔形角 

分 类 号：R683.2[医药卫生—骨科学]