明胶海绵结合二次球囊扩张技术对经皮椎体后凸成形术骨水泥渗漏的影响  

Feasibility analysis of using gelatin sponge combined with secondary balloon dilation technique to reduce bone cement leakage during percutaneous kyphoplasty

作　　者：康肖[1] 孙美岭 刘静培 代炜炜 李月轩 王清和[1] 裴世深[1] KANG Xiao;SUN Meiling;LIU Jingpei;DAI Weiwei;LI Yuexuan;WANG Qinghe;PEI Shishen(Department of Orthopaedics,The Fourth People's Hospital of Hengshui,Hengshui 053000,Hebei;Operating Room,The Fourth People's Hospital of Hengshui,Hengshui 053000,Hebei,China)

机构地区：[1]河北省衡水市第四人民医院骨科,河北衡水053000 [2]河北省衡水市第四人民医院手术室,河北衡水053000

出　　处：《中华骨与关节外科杂志》2023年第7期590-595,共6页Chinese Journal of Bone and Joint Surgery

基　　金：河北省衡水市科技计划项目(2019014010Z)。

摘　　要：目的:探讨经皮椎体后凸成形术(PKP)应用明胶海绵结合二次球囊扩张技术治疗骨质疏松性椎体压缩骨折对骨水泥渗漏的影响。方法:2018年1月至2020年6月行PKP应用明胶海绵结合二次球囊扩张技术治疗的145例骨质疏松性椎体压缩骨折患者纳入联合手术组,行PKP治疗的152例骨质疏松性椎体压缩骨折患者纳入常规手术组。比较两组患者的手术相关指标,术前和术后3个月的疼痛、关节功能、影像学检测指标,以及并发症发生情况。结果:与常规手术组比较,联合手术组的手术时间更长,骨水泥弥散系数更高(P<0.05)。两组患者随访时间3~14个月,平均(7.6±3.3)个月。与术前比较,两组患者术后3个月的视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、Cobb角均降低(P<0.05),但两组间比较差异无统计学意义(P>0.05)。与术前比较,两组患者术后3个月的日本骨科协会(JOA)评分、伤椎前缘高度、Beck指数、椎体中部高度均提高(P<0.05),但两组间比较差异无统计学意义(P>0.05)。术后3个月,联合手术组骨水泥渗漏发生率低于常规手术组(P<0.05)。结论:PKP应用明胶海绵结合二次球囊扩张技术治疗骨质疏松性椎体压缩骨折时,在缓解疼痛、改善功能、促进伤椎解剖结构恢复的基础上,可明显降低骨水泥渗漏的发生率,改善骨水泥弥散情况。Objective:To study the feasibility of using gelatin sponge combined with secondary balloon dilation technique to reduce bone cement leakage in patients with osteoporotic vertebral compression fractures during percutaneous kyphoplasty(PKP).Methods:From January 2018 to June 2020,145 patients with osteoporotic vertebral compression fractures who received PKP using gelatin sponge and secondary balloon dilation technique were included in the combination group,and 152 patients with osteoporotic vertebral compression fractures who received PKP during the same period were included in the control group.Operation related indexes,pain and joint function as well as imaging indicators before the operation and 3 months after the operation,and complications were compared between the two groups.Results:Compared with the control group,the operation time was longer and the diffusion coefficient of bone cement was higher in the combination group(P<0.05).All patients were followed up for 3-14 months with the mean of(7.6±3.3)months.Compared with that before surgery,scores of visual analogue scale(VAS),Oswestry dysfunction index(ODI)and Cobb's angle of the two groups decreased 3 months after surgery(P<0.05),but there was no statistical difference between the two groups(P>0.05).Compared with that before surgery,the scores of Japanese Orthopaedic Association(JOA),anterior edge height of injured vertebrae,Beck index,and middle vertebral body height of the two groups increased(P<0.05),but there was no statistical difference between the two groups(P>0.05).The incidence of bone cement leakage in the combination group was lower than that in the control group 3 months after surgery(P<0.05).Conclusions:The application of gelatin sponge combined with secondary balloon dilation technique in PKP for osteoporotic fractures can reduce the incidence of bone cement leakage and improve the diffusion of bone cement on the basis of relieving pain,improving function and promoting the recovery of anatomical structure of injured vertebrae.

关 键 词：骨质疏松性椎体压缩骨折 经皮椎体后凸成形术 明胶海绵 关节功能 并发症 

分 类 号：R683.2[医药卫生—骨科学]