个体化单侧椎弓根外入路与双侧椎弓根入路椎体成形后骨水泥的弥散效果  

Dispersion effect of bone cement after vertebroplasty using individualized unilateral external pedicle approach and bilateral pedicle approach

作　　者：张立创 杨雯 丁广江 李培坤 肖忠宇 陈营 方雪 张腾 Zhang Lichuang;Yang Wen;Ding Guangjiang;Li Peikun;Xiao Zhongyu;Chen Ying;Fang Xue;Zhang Teng(People’s Hospital of Jiawang District,Xuzhou 221100,Jiangsu Province,China)

机构地区：[1]江苏省徐州市贾汪区人民医院,江苏省徐州市221100

出　　处：《中国组织工程研究》2025年第4期800-808,共9页Chinese Journal of Tissue Engineering Research

基　　金：2023年徐州市卫生健康委医学科技创新项目-青年项目(XWKYHT20230083),项目负责人:张腾;白求恩-医学科学研究基金项目(B19370ES),项目负责人:张腾。

摘　　要：背景:目前已有的临床研究认为,椎弓根外入路与椎弓根入路行椎体成形治疗均可改善脊柱压缩骨折患者的疼痛并改善其生活质量,相较于椎弓根入路相比,椎弓根外入路的穿刺角度更加自由,可通过调整穿刺外倾角获得良好的骨水泥弥散效果。目的:通过量化骨水泥弥散效果,对比个体化单侧椎弓根外入路与双侧椎弓根入路行椎体成形治疗脊柱压缩性骨折的效果。方法:纳入80例胸腰椎压缩骨折患者,采用随机数字表法分为2组,双侧椎弓根组(n=40)接受双侧椎弓根入路椎体成形手术,单侧椎弓根外组(n=40)接受个体化单侧椎弓根外入路椎体成形手术。术后3 d内拍摄患椎正侧位X射线片,评估骨水泥弥散效果、弥散类型。术前及术后1 d、7 d、1个月,评估患者目测类比评分、骨折周围压痛阈值、Oswestry功能障碍指数。结果与结论:①单侧椎弓根外组患者骨水泥弥散效果优于双侧椎弓根组(P<0.001),骨水泥灌注量多于双侧椎弓根组(P<0.001);双侧椎弓根入路组骨水泥弥散类型主要集中在Ⅰ型和Ⅲ型,单侧椎弓根外组骨水泥弥散类型主要集中在Ⅰ型和Ⅱ型,两组骨水泥弥散类型比较差异有显著性意义(P<0.001);②两组患者术后的目测类比评分、Oswestry功能障碍指数均低于术前(P<0.001),术后骨折周围压痛阈值呈现先降低后升高的趋势;治疗后相同时间点,两组间目测类比评分、Oswestry功能障碍指数、骨折周围压痛阈值比较差异均无显著性意义(P>0.05);③结果表明,个体化单侧椎弓根外入路椎体成形手术可获得更好的骨水泥弥散效果,并且治疗效果与经典双侧椎弓根入路椎体成形手术一致。BACKGROUND:According to existing clinical studies,vertebroplasty treatment with both the external pedicle approach and the pedicle approach can improve the pain and quality of life of patients with spinal compression fractures.Compared with the pedicle approach,the external pedicle approach has a freer puncture angle,and good bone cement dispersion effect can be obtained by adjusting the puncture angle.OBJECTIVE:To compare the impact of vertebroplasty through individualized unilateral external pedicle approach and bilateral pedicle approach on the treatment of spinal compression fractures by quantifying the dispersion effect of bone cement.METHODS:A total of 80 patients with thoracolumbar compression fracture were divided into two groups by random number table method.The bilateral pedicle group(n=40)underwent vertebroplasty through a bilateral pedicle approach,while the unilateral external pedicle group(n=40)underwent individualized vertebroplasty through a unilateral external pedicle approach.Anteroposterior and lateral X-rays of the affected vertebrae from two groups of patients were photographed to assess effect and type of bone cement dispersion within 3 days after surgery.Visual analog scale score,tenderness threshold around fracture,and Oswestry dysfunction index were assessed before,1,7 days,and 1 month after surgery.RESULTS AND CONCLUSION:(1)Dispersion effect of bone cement in unilateral external pedicle group was better than that in bilateral pedicle group(P<0.001),and the amount of bone cement perfusion was higher than that in bilateral pedicle group(P<0.001).In the bilateral pedicle group,the bone cement dispersion types were mainly concentrated in type I and type III,while in the unilateral external pedicle group,the bone cement dispersion types were mainly concentrated in type I and type II,and there was a significant difference in bone cement dispersion types between the two groups(P<0.001).(2)Postoperative visual analog scale scores and Oswestry disability index of both groups were lower than those

关 键 词：脊柱压缩性骨折 经皮椎体成形术 双侧椎弓根入路 单侧椎弓根外入路 骨水泥弥散 骨质疏松 

分 类 号：R459.9[医药卫生—治疗学] R318.08[医药卫生—临床医学] R683