单侧经横突上缘椎体侧壁入路的临床研究  

Clinical study of unilateral pyramidal approach through the superior edge of transverse process

作　　者：魏嘉良 朱宇[1] 李毅[1] 李高磊 卢文龙 樊晓韩 黎少言 张跃[1] 梁龙博 王泽渊 Wei Jialiang;Zhu Yu;Li Yi;Li Gaolei;Lu Wenlong;Fan Xiaohan;Li Shaoyan;Zhang Yue;Liang Longbo;Wang Zeyuan(Department of Orthopedics,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014,China)

机构地区：[1]郑州大学第二附属医院骨科二病区,450014

出　　处：《中华实验外科杂志》2022年第8期1595-1598,共4页Chinese Journal of Experimental Surgery

摘　　要：目的验证单侧经横突上椎体侧壁入路安全可靠性, 与临床中运用最广泛的单侧经椎弓根入路治疗骨质疏松性椎体压缩骨折(OVCF)的各项数据对比, 探讨单侧经横突上缘椎体侧壁入路在球囊扩张椎体后凸成形术(PKP)中的应用价值。方法运用3D Slicer印证经横突上缘椎体侧壁入路简单安全可靠;收集郑州大学第二附属医院自2019年11月至2020年12月的77例患者, 分别为运用单侧经横突上缘椎体侧壁入路患者40例和单侧经椎弓根入路患者37例, 对比两种入路患者治疗过程中的各项指标及远期治疗效果。结果两组患者均完成治疗, 无并发症;两组患者术后ODI和VAS均显著降低(t=0.000, P<0.05), 且评分差异无统计学意义(两组患者术前VASt=0.690, 术后VASt=0.231, 术后3个月VASt=0.866;术前ODIt=0.979, 术后ODIt=0.563, 术后3个月ODIt=0.375, P>0.05);椎体高度恢复差异无统计学意义(t=0.684, P>0.05);术中骨水泥灌注量差异无统计学意义(t=0.912, P>0.05);而单侧经横突上椎体侧壁入路组在手术时长[15(14~16) min比22(20~24) min, t=0.000, P<0.05]、建立通道透视次数[5(4.00~6.00)比10(8.00~10.75), t=0.000, P<0.05]均优于单侧经椎弓根入路患者组;且术后X线回示骨水泥灌注位于椎体前缘正中线(35比5, t=0.000, P<0.05)。结论两种入路均能使患者得到满意治疗效果, 椎体侧壁组可使骨水泥推注椎体前缘且过椎体中线, 生物力学更稳定, 且手术时间短, 透视次数少, 不易伤及脊髓, 操作简便且安全可靠。Objective To verify the safety and reliability of the unilateral approach through the lateral wall of the superior pyramidal transverse process,compare and analyze the data of the unilateral approach through the pedicle in the treatment of osteoporotic vertebral compression fracture,and discuss the application value of the unilateral approach through the lateral wall of the superior pyramidal transverse process in kyphoplasty with balloon expansion.Methods The 3D Slicer was used to verify the simple,safe and reliable approach through the lateral wall of the cone at the upper edge of the transverse process.A total of 77 patients in our hospital from November 2019 to December 2020 were collected,including 40 patients with unilateral lateral wall approach through the upper edge of the transverse process and 37 patients with unilateral pedicle approach,respectively.The indicators in the treatment process and long-term treatment effects of the two approaches were compared.Results Both groups completed treatment without complications.Postoperative ODI and VAS in two groups were significantly decreased(t=0.000,P<0.05),and there was no statistically significant difference in scores(preoperative VAS t=0.690,postoperative VAS t=0.231,postoperative VAS t=0.866;preoperative ODI t=0.979,postoperative ODI t=0.563,postoperative 3-month ODI t=0.375,P>0.05).There was no statistically significant difference in vertebral height recovery(t=0.684,P>0.05).There was no significant difference in intraoperative bone cement perfusion(t=0.912,P>0.05).The operation duration[15(14-16)min vs.22(20-24)min,t=0.000,P<0.05]was shortened and the number of fluoroscopic channels[5(4.00-6.00)vs.10(8.00-10.75),t=0.000,P<0.05]was reduced in the unilateral transpedicle approach group as compared with those in the unilateral transpedicle approach group.Postoperative X-ray results showed that bone cement perfusion was located in the median line of the anterior margin of the vertebral body(35 vs.5,t=0.000,P<0.05).Conclusion Both approaches can make patient

关 键 词：椎体压缩骨折 经皮球囊扩张椎体成形术 经横突上椎体侧壁入路 经椎弓根入路 单侧入路 

分 类 号：R687.3[医药卫生—骨科学]