骨质疏松性胸腰椎压缩骨折双侧穿刺经皮椎体成形术中不同层面穿刺对骨水泥分布与疗效的影响研究  

Effects of different puncture levels in bilateral percutaneous vertebroplasty on distribution of bone cement and effectiveness of osteoporotic thoracolumbar compression fractures

作　　者：谢胜荣 陈冬梅[1] 王艳 吴林峰 何源亮[1] 王杰 董迎春[1] 陈展宇[1] XIE Shengrong;CHEN Dongmei;WANG Yan;WU Linfeng;HE Yuanliang;WANG Jie;DONG Yingchun;CHEN Zhanyu(Department of Orthopaedics,the First People’s Hospital of Longquanyi District of Chengdu,Chengdu Sichuan,610100,P.R.China;Department of Surgery,Longquanyi District of Chengdu Maternity and Child Health Care Hospital,Chengdu Sichuan,610100,P.R.China)

机构地区：[1]成都市龙泉驿区第一人民医院骨科,成都610100 [2]成都市龙泉驿区妇幼保健院外科,成都610100

出　　处：《中国修复重建外科杂志》2023年第3期329-335,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：四川省医学会骨科(尚安通)专项科研课题(2020SAT25)。

摘　　要：目的探讨双侧穿刺经皮椎体成形术治疗骨质疏松性胸腰椎压缩骨折中,不同层面穿刺对骨水泥分布与疗效的影响。方法回顾分析2017年12月—2020年12月收治并符合选择标准的274例骨质疏松性胸腰椎压缩骨折患者临床资料,均行双侧穿刺经皮椎体成形术。根据术中C臂X线机侧位透视穿刺针针尖最终到达位置分组,118例双侧穿刺针针尖位于同一层面(A组);156例双侧穿刺针针尖位于不同层面(B组),其中87例分别位于上1/3层和下1/3层(B1组),69例位于相邻层面(B2组)。A、B组间以及A、B1、B2组间患者性别、年龄、骨折节段、骨质疏松程度、病程以及术前疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)比较,差异均无统计学意义(P>0.05)。比较各组手术时间、骨水泥注入量、术后疼痛VAS评分及ODI,影像学复查骨水泥分布情况。结果各组手术均顺利完成,未出现骨水泥渗漏导致神经压迫症状,无肺栓塞、穿刺针道感染发生。A、B组间以及A、B1、B2组间手术时间、骨水泥注入量比较,差异均无统计学意义(P>0.05)。患者术后均获随访,随访时间3~32个月,平均7.8个月;A、B组间以及A、B1、B2组间随访时间比较,差异均无统计学意义(P>0.05)。术后3 d及末次随访时,B组VAS评分、ODI均低于A组;B1、B2组低于A组,B1组低于B2组;差异均有统计学意义(P<0.05)。影像学复查示B组伤椎冠状位中线骨水泥分布优于A组;B1、B2组优于A组,B1组优于B2组;差异均有统计学意义(P<0.05)。随访期间,A组7例发生手术椎体塌陷,8例出现其他椎体骨折;B组仅1例发生手术椎体塌陷。结论采用双侧穿刺经皮椎体成形术治疗骨质疏松性胸腰椎压缩骨折时,术中穿刺针针尖位于不同层面能获得良好的伤椎骨水泥分布与疗效。当针尖分别位于椎体上1/3层与下1/3层时,穿刺部位距离上、下终板较近,注入的骨水泥更容易连接上、下终板。Objective To investigate the effects of different puncture levels on bone cement distribution and effectiveness in bilateral percutaneous vertebroplasty for osteoporotic thoracolumbar compression fractures.Methods A clinical data of 274 patients with osteoporotic thoracolumbar compression fractures who met the selection criteria between December 2017 and December 2020 was retrospectively analyzed.All patients underwent bilateral percutaneous vertebroplasty.During operation,the final position of the puncture needle tip reached was observed by C-arm X-ray machine.And 118 cases of bilateral puncture needle tips were at the same level(group A);156 cases of bilateral puncture needle tips were at different levels(group B),of which 87 cases were at the upper 1/3 layer and the lower 1/3 layer respectively(group B1),and 69 cases were at the adjacent levels(group B2).There was no significant difference in gender,age,fracture segment,degree of osteoporosis,disease duration,and preoperative visual analogue scale(VAS)score,and Oswestry disability index(ODI)between groups A and B and among groups A,B1,and B2(P>0.05).The operation time,bone cement injection volume,postoperative VAS score,ODI,and bone cement distribution were compared among the groups.Results All operations were successfully completed without pulmonary embolism,needle tract infection,or nerve compression caused by bone cement leakage.There was no significant difference in operation time and bone cement injection volume between groups A and B or among groups A,B1,and B2(P>0.05).All patients were followed up 3-32 months,with an average of 7.8 months.There was no significant difference in follow-up time between groups A and B and among groups A,B1,and B2(P>0.05).At 3 days after operation and last follow-up,VAS score and ODI were significantly lower in group B than in group A(P<0.05),in groups B1 and B2 than in group A(P<0.05),and in group B1 than in group B2(P<0.05).Imaging review showed that the distribution of bone cement in the coronal midline of injured vertebr

关 键 词：骨质疏松性椎体压缩骨折 胸腰椎骨折 经皮椎体成形术 双侧穿刺 骨水泥分布 

分 类 号：R687.3[医药卫生—骨科学]