二维CT与C型臂X线引导椎体成形术治疗骨质疏松性椎体压缩性骨折的疗效比较  

Comparing the effects of two-dimensional CT and C-arm guided percutaneous vertebroplasty for the treatment of patients with osteoporosis vertebral compression fracture

作　　者：邓硕[1] 万权[2] 曾振华[1] 戴仪[1] 李顺[2] Deng Shuo;Wan Quan;Zeng Zhenhua;Dai Yi;Li Shun(Department of Pain Management,the First People's Hospital of Jiashan,Jiaxing City,Zhejiang Province 314100,China;Department of Pain Management,Zhejiang Provincial People's Hospital,Hangzhou City,Zhejiang Province 310014,China)

机构地区：[1]嘉善县第一人民医院疼痛科,浙江省嘉兴市314100 [2]浙江省人民医院疼痛科,杭州市310014

出　　处：《中华疼痛学杂志》2021年第5期496-502,共7页Chinese Journal Of Painology

基　　金：浙江省医学会疼痛医学科研项目(艾瑞专项2016ZYC-A78);嘉善县级科技计划项目(2016A14)。

摘　　要：目的比较二维CT与C型臂X线在引导经皮椎体成形术(PVP)治疗骨质疏松性椎体压缩性骨折(OVCF)中的应用价值。方法收集2016年12月至2018年12月期间嘉善县第一人民医院疼痛科诊治的120例单节段OVCF接受PVP治疗的患者,性别不限,年龄57~91岁;数字等级评分(NRS)≥4分,脊柱Roland Morris功能障碍调查表(RMDQ)评分≥10分。采用随机数字表法将患者随机分为二维CT组和C型臂X线组,每组60例,分别在两种不同引导技术下将穿刺针经皮穿刺到病变椎体后,向椎体内填充骨水泥。比较两组术前、术后3 d和术后6个月时NRS和RMDQ评分。同时比较两组穿刺次数、手术时间和骨水泥注入量。结果120例患者手术均顺利完成,且未见严重并发症。二维CT组术后3 d和术后6个月时的NRS评分分别为(3.1±0.4)、(2.7±0.5)分,C型臂X线组术后3 d和术后6个月时的NRS评分分别为(3.2±0.7)、(2.8±0.6)分,两组患者术后3 d和术后6个月时的NRS评分较术前均明显降低(P均<0.05),但各时点两组间NRS评分比较差异无统计学意义(P均>0.05)。二维CT组术后3 d和术后6个月时的RMDQ评分分别为(13.2±1.5)、(12.6±1.3)分,C型臂X线组术后3 d和术后6个月时的RMDQ评分分别为(12.8±1.6)、(12.2±1.7)分,两组患者术后3 d和术后6个月时的RMDQ评分较术前均明显降低(P均<0.05),但各时点两组间RMDQ评分比较差异无统计学意义(P均>0.05)。二维CT组患者穿刺次数、手术时间和骨水泥注入量分别为(4.5±1.2)次、(26±11)min、(1.6±1.2)ml,C型臂X线组患者穿刺次数、手术时间和骨水泥注入量分别为(7.8±1.6)次、(39±16)min、(2.7±1.4)ml,两组上述3项指标比较差异均有统计学意义(P均<0.05)。结论采用二维CT或C型臂X线引导行PVP治疗OVCF临床效果均良好,但前者定位更精确,可减少术中穿刺次数及手术时间。Objective To compare the effects of two-dimensional CT(2D-CT)and X-ray guidance in percutaneous vertebroplasty(PVP)for osteoporosis vertebral compression fracture(OVCF).Methods From December 2016 to December 2018,120 patients with single segment OVCF treated with PVP were collected in the Department of Pain Management,the First People's Hospital of Jiashan,both sexes,aged 57-91 years old,numerical grading score(NRS)≥4 points,and the spinal Roland Morris dysfunction score(RMDQ)≥10.All patients were randomly divided into 2D-CT group and C-arm X-ray group with random number table method,60 cases in each group.Under two different guidance techniques,the needle was punctured into the diseased vertebral body through skin,and then bone cement was filled into the vertebral body.NRS and RMDQ were recorded before the operation,and 3 days,6 months after the operation.The number of puncture,the time of operation and the amount of bone cement injected were recorded also in the two groups.Results All cases were successfully completed without serious complications appeared in the two groups.NRS was(3.1±0.4)and(2.7±0.5)in the 2D-CT group,and(3.2±0.7)and(2.8±0.6)in the C-arm X-ray group at 3 days and 6 months after the operation respectively,which was significantly lower at 3 days and 6 months after the operation than that before the operation in the two groups(all P<0.05),but there was no significant difference between the two groups at each time point(all P>0.05).RMDQ score was(13.2±1.5)and(12.6±1.3)at 3 days and 6 months after the operation in the 2D-CT group respectively.While RMDQ score was(12.8±1.6)and(12.2±1.7)at 3 days and 6 months after the operation in the C-arm X-ray group respectively.RMDQ score was significantly lower at 3 days and 6 months after the operation than that before the operation in the two groups(all P<0.05),but there was no significant difference between the two groups at each time point(all P>0.05).The number of puncture,operation time and bone cement volume injected were(4.5±1.2)times,(26�

关 键 词：骨质疏松性骨折 脊柱骨折 体层摄影术 螺旋计算机 体层摄影术 X线 

分 类 号：R687.3[医药卫生—骨科学]