单侧二次穿刺经皮椎体成形术治疗ⅡA型急性症状性骨质疏松性胸腰椎骨折的疗效分析  

Unilateral secondary puncture percutaneous vertebroplasty for acute symptomatic osteoporotic thoracolumbar fractures of typeⅡA

作　　者：李庆达 贺宝荣[1] 刘松旗 杨俊松[1] 王晓晖 何昌军 刘团江[1] 高林[1] 柴鑫 徐辉[1] 田欣 郝定均[1] Li Qingda;He Baorong;Liu Songqi;Yang Junsong;Wang Xiaohui;He Changjun;Liu Tuanjiang;Gao Lin;Chai Xin;Xu Hui;Tian Xin;Hao Dingjun(Department of Spine Surgery,Honghui Hospital,Xi'an Jiaotong University,Xi'an 710054,China)

机构地区：[1]西安交通大学附属红会医院脊柱病医院,西安710054

出　　处：《中华创伤骨科杂志》2022年第7期583-590,共8页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金(81830077,81772357)。

摘　　要：目的探讨单侧二次穿刺经皮椎体成形术(PVP)治疗急性症状性骨质疏松性胸腰椎骨折(ASOTLF)分型ⅡA型的疗效。方法回顾性分析2016年2月至2018年10月西安交通大学附属红会医院脊柱病医院收治的193例ⅡA型ASOTLF患者临床资料。男71例,女122例;年龄65~90岁[(73.9±4.3)岁];致伤节段:T1021例,T1127例,T1244例,L148例,L229例,L314例,L410例。其中85例接受单侧二次穿刺PVP治疗(观察组),108例未接受单侧二次穿刺PVP治疗(对照组)。通过比较两组患者手术时间、骨水泥注入量、术中出血量、住院时间,术前、术后3 d及末次随访时的腰背部视觉模拟评分(VAS)、脊柱Oswestry功能障碍指数(ODI)、伤椎椎体前缘高度(AH)和伤椎后凸角(KA)评估疗效;观察骨水泥渗漏和相邻椎体骨折发生情况。结果所有患者术后获12~24个月(平均15.8个月)随访。两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。观察组手术时间、骨水泥注入量[(36.2±1.4)min、(5.5±0.7)mL]均显著长于或多于对照组[(32.3±1.7)min、(4.0±0.7)mL](P<0.05)。两组患者住院时间和术中出血量比较差异均无统计学意义(P>0.05)。术后3 d及末次随访时两组患者VAS、ODI、AH、KA均较术前改善,差异有统计学意义(P<0.05)。术前及术后3 d VAS、ODI、AH、KA两组间比较差异均无统计学意义(P>0.05)。但末次随访时观察组VAS、ODI、AH、KA[(2.2±0.8)分、19.2%±5.8%、(2.90±0.21)cm、12.2°±1.5°]优于对照组[(3.1±0.9)分、22.8%±5.3%、(2.41±0.15)cm、13.3°±1.2°]。两组患者术后骨水泥渗漏和相邻椎体骨折发生率比较差异均无统计学意义(P>0.05)。结论单侧二次穿刺PVP术治疗ⅡA型ASOTLF疗效满意,可有效增加骨水泥弥散,防止术椎再次塌陷,且不会增加骨水泥渗漏或相邻椎骨骨折的风险。Objective To explore the clinical effects of unilateral secondary puncture percutaneous vertebroplasty(PVP)in the treatment of typeⅡA acute symptomatic osteoporotic thoracolumbar fractures(ASOTLF).Methods A retrospective case-control study was conducted to analyze the clinical data of 193 patients with typeⅡA ASOTLF who had been admitted to Department of Spine Surgery,Honghui Hospital from February 2016 to October 2018.They were 71 males and 122 females,aged from 65 to 90 years[average,(73.9±4.3)years].The segments injured were T10 in 21 cases,T11 in 27 cases,T12 in 44 cases,L1 in 48 cases,L2 in 29 cases,L3 in 14 cases,and L4 in 10 cases.Of them,85 received unilateral secondary puncture PVP(observation group)and 108 did not(control group).The clinical effects were evaluated by comparing between the 2 groups the operation time,bone cement injection volume,intraoperative blood loss,hospital stay,and visual analogue scale(VAS)for back pain,spinal Oswestry disability index(ODI),anterior height of the injured vertebral body(AH)and kyphosis angle(KA)of the injured vertebra before operation,at 3 days after operation and the last follow-up.The bone cement leakage and fracture of adjacent vertebral body were observed.Results All patients were followed up for 12 to 24 months(average,15.8 months).There was no significant difference in the preoperative general data between the 2 groups,showing they were comparable(P>0.05).The operation time and bone cement injection volume[(36.2±1.4)min and(5.5±0.7)mL]in the observation group were significantly longer or more than those in the control group[(32.3±1.7)min and(4.0±0.7)mL](P<0.05).There was no significant difference in the hospital stay or intraoperative blood loss between the 2 groups(P>0.05).The VAS,ODI,AH and KA at 3 days after operation and the last follow-up were significantly improved compared with those before operation in both groups(P<0.05).There was no significant difference in VAS,ODI,AH or KA between the 2 groups before operation or at 3 days after operatio

关 键 词：老年人 骨质疏松 脊柱骨折 椎体成形术 骨粘合剂 

分 类 号：R687.3[医药卫生—骨科学]