三种穿刺经皮椎体成形术的比较  

Comparison of three puncture techniques used for percutaneous vertebroplasty

作　　者：李晖[1] 孟祥翔[1] 张超远[1] LI Hui;MENG Xiang-xiang;ZHANG Chaoyuan(Department of Orthopedics,Nanyang Central Hospital,Nanyang 473000,China)

机构地区：[1]南阳市中心医院骨三科,河南南阳473000

出　　处：《中国矫形外科杂志》2023年第15期1363-1367,共5页Orthopedic Journal of China

基　　金：河南省医药卫生科技计划项目课题(编号:N-1354)。

摘　　要：[目的]比较三种穿刺椎体成形术(percutaneous vertebroplasty, PVP)治疗骨质疏松性压缩骨折(osteoporotic compression fracture, OVCF)的临床与影像结果。[方法]选择2019年3月—2020年3月本科收治的83例骨质疏松性椎体压缩骨折患者,随机分为3组,单侧组27例,双侧组28例和弯角(percutaneous curved vertebroplasty, PCVP)组28例,分别行相应穿刺PVP术。比较三组患者围手术期、随访及影像结果。[结果]所有患者均顺利完成手术,无严重并发症。双侧组的手术时间和住院费用均显著高于单侧组和弯角组(P<0.05)。弯角组骨水泥注入量显著大于单侧组和双侧组[(4.1±0.6) ml vs (3.4±0.3) ml vs(3.5±0.3) ml, P=0.029],而弯角组骨水泥渗漏率显著低于单侧组和双侧组[0.0%vs 22.2%vs10.7%, P=0.029]。所有患者随访(13.7±1.2)个月,随时间推移,三组VAS、ODI评分均显著降低(P<0.05)。术前三组间VAS、ODI评分的差异均无统计学意义(P>0.05),但末次随访时,双侧组和弯角组ODI评分显著优于单侧组[(23.7±3.8) vs (23.7±3.6) vs (26.0±3.6), P=0.029]。影像方面,双侧组、弯角组的伤椎骨水泥弥散分布优秀率显著高于单侧组[85.7%vs 82.1%vs 59.3%, P=0.045]。与术前相比,术后1个月及末次随访时三组患者椎体前缘高度显著增加(P<0.05),而Cobb角显著降低(P<0.05)。末次随访时,弯角组椎体前缘高度、Cobb角丢失比例小于双侧组与单侧组,但差异并无统计学意义(P>0.05)。[结论] CVP能够增加骨水泥推注的准确性,降低骨水泥渗漏风险,改善OVCF患者远期功能。[Objective]To compare the clinical and imaging consequences of three puncture techniques used in percutaneous vertebro⁃plasty(PVP)for osteoporotic compression fracture(OVCF).[Methods]A total of 83 patients with OVCF admitted to our department from March 2019 to March 2020 were enrolled into this study and randomly divided into 3 groups.Of them,27 patients received unilateral PVP(the uPVP group),28 cases underwent bilateral PVP(the bPVP group)and 28 cases had percutaneous curved vertebroplasty performed(the PCVP group).The documents regarding to perioperative period follow-up and radiographs were compared among the three groups.[Results]All patients were successfully operated on without serious complications.The bPVP group consumed significantly longer operation time,with more times of fluoroscopy and greater hospitalization cost than the uPVP and PCVP groups(P<0.05).The PCVP group had significantly more bone cement injected[(4.1±0.6)ml vs(3.4±0.3)ml vs(3.5±0.3)ml,P=0.029],whereas significantly lower incidence of cement leakage[0.0%vs 22.2%vs10.7%,P=0.029]than the uPVP and bPVP groups.As time went during the follow-up lasted for(13.7±1.2)months,the VAS and ODI scores significantly decreased in all the three groups(P<0.05).Although there were no statistically significant differences in VAS and ODI scores among the three groups before surgery(P>0.05),the PCVP and bPVP groups proved significantly superior to the uPVP group in ODI score[(23.7±3.8)vs(23.7±3.6)vs(26.0±3.6),P=0.029]at the latest follow-up(P<0.05).Radiographically,PCVP and bPVP groups proved significantly superior to the uPVP group in term of excellent rate of bone cement distribution in vertebral body[85.7%vs 82.1%vs 59.3%,P=0.045].Compared with those preoperatively,the anterior vertebral height was significantly increased(P<0.05),while Cobb angle was significantly decreased in all the three groups postoperatively(P<0.05).At the latest follow-up,the PCVP group had less loss in term of anterior vertebral height and correction of local kyphosis in

关 键 词：骨质疏松性骨折 经皮椎体成形术 穿刺方法 骨水泥 疗效 

分 类 号：R687[医药卫生—骨科学]