回形针体表定位联合CT测量在骨质疏松性椎体压缩性骨折经皮椎体后凸成形术个体化穿刺中的应用  

Application of Paper Clip Surface Positioning combined with CT Measurement in Individualized Puncture of Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fractures

作　　者：李翰林 陈程 陈亮[3] 顾勇[3] 计小东 王云根 晋存 刘耀辉 黄凯 Li Hanlin;Chen Cheng;Chen Liang;Gu Yong;Ji Xiaodong;Wang Yungen;Jin Cun;Liu Yaohui;Huang Kai(Wujiang District Hospital of Traditional Chinese Medicine,Suzhou City,the Second People′s Hospital of Wujiang District,Suzhou City,Jiangsu,Suzhou 215221,China)

机构地区：[1]江苏省苏州市吴江区中医医院,江苏省苏州市吴江区第二人民医院,江苏苏州215221 [2]扬州大学医学院,江苏扬州225003 [3]苏州大学附属第一医院,江苏苏州215006

出　　处：《中国中医急症》2023年第11期1944-1948,共5页Journal of Emergency in Traditional Chinese Medicine

基　　金：江苏省苏州市民生科技医疗卫生应用基础研究(SYSD2019047);2023年度苏州市吴江“科教兴卫”项目(WWK202304)。

摘　　要：目的 观察回形针体表定位联合术前CT测量在骨质疏松性椎体压缩性骨折经皮后凸椎体成形术中个体化穿刺的应用有效性及安全性,并探讨其作用机制。方法 70例患者随机分为治疗组与对照组各35例。对照组采用常规C臂机透视下徒手经椎弓根穿刺PKP治疗。治疗组根据术前CT测量确定穿刺外展角,采用回形针体表定位确定穿刺点后在C臂机引导下行PKP治疗。观察并记录两组患者手术完成时间、术中透视次数、骨水泥注入量、椎体内骨水泥分布情况,以疼痛视觉模拟评分(VAS)评估术前、术后6 h、24 h、3 d、7 d疼痛情况。记录骨水泥渗漏、神经损伤等并发症发生情况。结果 所有患者均成功完成手术,无脊髓或神经损伤发生、无脑脊液漏发生,部分病例出现骨水泥渗漏至血管、椎间隙等情况,均无临床症状发生。治疗组完成手术时间、透视次数均短于对照组(均P<0.05)。两组椎体内骨水泥注入量比较接近,差异无统计学意义(P>0.05)。治疗组椎体内骨水泥分布与对照组比较,分布更靠近棘突中线,弥散更均匀,差异有统计学意义(P<0.05)。两组术前VAS评分比较,差异无统计学意义(P> 0.05)。两组术后6 h、24 h、3 d、7 d的VAS评分均低于术前(均P<0.05),且治疗组术后6、24 h的VAS评分均低于对照组(均P<0.05);但两组术后3、7 d的VAS评分比较则无统计学差异(均P> 0.05)。结论 回形针体表定位联合术前CT测量辅助下的个体化穿刺较徒手穿刺可减少手术时间及术中透视次数,术后早期疼痛缓解更好,并使骨水泥更好地弥散至棘突中线对侧。Objective:To observe the effectiveness and safety of paper clip surface positioning combined with preoperative CT measurement in the application of individualized puncture in percutaneous kyphoplasty for osteoporotic vertebral compression fractures.Method:70 patients with osteoporotic vertebral compression fracture(OVCF)were randomly divided into two groups,35 cases in each group.The control group was treated with PKP by manual transpedicular puncture under conventional C-arm fluoroscopy.In the treatment group,the abduction angle of puncture was determined according to the preoperative CT measurement,and the puncture point was determined by positioning the body surface with a paper clip,and then PKP was performed under the guidance of a Carm machine.The operation completion time,intraoperative fluoroscopy times,the amount of bone cement injected,and the distribution of bone cement in the vertebral body were observed and recorded in the two groups.The pain was evaluated by visual analogue scale(VAS)before operation,6 hours,24 hours,3 days,and 7 days after operation.Complications such as bone cement leakage and nerve injury were recorded.Results:All patients successfully completed the operation,without spinal cord or nerve injury,cerebrospinal fluid leakage,and bone cement leak-age to blood vessels and intervertebral space in some cases,without clinical symptoms.The operation completiontime and intraoperative fluoroscopy times in the treatment group were significantly lower than those in the controlgroup,the difference was statistically significant(P<0.05).The difference was not statistically significant in aver-age bone cement injection volume between the two groups(P<0.05).In the treatment group,the distribution ofbone cement in the vertebral body tended to the middle line of spinous process,and the difference was statisticallysignificant(P<0.05).The VAS scores at 6 h,24 h after operation in the treatment group were significantly lowerthan those in the control group(P<0.05),but there was no significant difference

关 键 词：骨质疏松性椎体压缩性骨折 椎体成形术 回形针 CT 穿刺 

分 类 号：R683[医药卫生—骨科学]