在PVP治疗Kümmell病中不同穿刺路径对临床疗效及骨水泥分布的影响  

Effects of different puncture pathways on outcomes and bone cement distribution in PVP treatment of Kümmell disease

作　　者：张宏志 王晓宇 刘爽 Zhang Hongzhi;Wang Xiaoyu;Liu Shuang(Department of Orthopedics,Shunyi Hospital,Beijing 101300,China)

机构地区：[1]北京市顺义区医院骨一科,北京101300

出　　处：《创伤外科杂志》2024年第6期429-433,共5页Journal of Traumatic Surgery

摘　　要：目的探讨不同穿刺路径在经皮椎体成形术(PVP)治疗Kümmell病中的作用,分析其对手术效果和伤椎内骨水泥分布的影响。方法回顾性分析2020年2月—2022年3月北京市顺义区医院骨一科应用PVP治疗创伤后椎体骨坏死(Kümmell病)患者31例,男性10例,女性21例;年龄61~72岁,平均67.9岁;摔伤18例,道路交通伤8例,扭伤5例。根据手术穿刺路径不同分为腔隙外穿刺组(16例)与腔隙内穿刺组(15例)。比较两组患者手术时间、骨水泥渗漏、术中C型臂X线机透视次数、伤椎内骨水泥形态,术前及术后1d 3个月VAS、Oswestry功能障碍指数(ODI)及伤椎骨水泥是否松动。结果两组患者年龄、性别、BMI、骨密度、Kümmell病分型及致伤原因方面比较差异无统计学意义(P>0.05)。两组患者术后1 d VAS、ODI较术前均有降低[VAS:(8.8±0.5)分vs.(2.7±0.3)分、(8.7±0.6)分vs.(2.9±0.4)分;ODI:(89.5±3.6)%vs.(35.8±4.1)%、(91.4±4.3)%vs.(39.9±3.4)%,P<0.05],但组间比较差异无统计学意义(P>0.05);术后3个月VAS、ODI腔隙外穿刺组低于腔隙内穿刺组[(1.0±0.2)分vs.(3.1±0.3)分、(18.7±2.6)%vs.(35.8±3.1)%],差异有统计学意义(P<0.05)。两组患者手术时间、术中C型臂X线机透视次数[(30.5±7.3)min vs.(31.3±9.1)min、(28.3±3.1)次vs.(31.2±4.3)次]比较差异无统计学意义(P>0.05),但在骨水泥渗漏及骨水泥松动方面,腔隙外穿刺组优于腔隙内穿刺组(18.8%vs.46.7%、0 vs.26.7%),差异有统计学意义(P<0.05)。伤椎骨水泥分布方面,腔隙外穿刺组团块型占比18.8%,嵌压型占比81.2%,腔隙内穿刺组团块型占比73.3%,嵌压型占比26.7%,两组比较差异有统计学意义(P<0.05)。结论在PVP治疗Kümmell病中,应用腔隙外穿刺技术可改善伤椎骨水泥分布,降低骨水泥渗漏概率,在减少骨水泥松动方面具有优势,值得临床推广。Objective To explore the role of different puncture pathways in percutaneous vertebroplasty(PVP)treatment of Kümmell disease,and to analyze the impact on surgical outcomes and distribution of bone cement in the injured vertebrae.Methods A retrospective analysis was conducted on clinical data of 31 patients with traumatic vertebral osteonecrosis(Kümmell disease)treated by PVP in the Department of Orthopedics,Shunyi Hospital,from Feb.2020 to Mar.2022,including 10 males and 21 females aged 61-72(mean 67.9)years.There were 18 cases of falls,8 road traffic injuries,and 5 sprains.According to different surgical puncture pathways,16 patients were divided into extralacunar puncture group and 15 into intralacunar puncture group.The operation time,frequency of intraoperative C-arm fluoroscopy,incidence of bone cement leakage and loosening,and bone cement morphology in the injured vertebrae were analyzed.The VAS score and Oswestry disability index(ODI)before,1 d and 3 months after surgery were recorded.Results There was no statistically significant difference between the two groups in terms of age,gender,body mass index,bone density,Kümmell disease classification,or cause of injuries(all P>0.05).On the first day after surgery,both groups showed a decrease in VAS(extralacunar puncture group 8.8±0.5 vs.2.7±0.3,intralacunar puncture group 8.7±0.6 vs.2.9±0.4)and ODI(extralacunar puncture group 89.5%±3.6%vs.35.8%±4.1%,intralacunar puncture group 91.4%±4.3%vs.39.9%±3.4%,both P<0.05 compared with before surgery),but there was no statistically significant difference between the two groups(P>0.05).At 3 months of surgery,the extraluminal puncture group revealed a much lower VAS(1.0±0.2 vs.3.1±0.3)and ODI(18.7%±2.6%vs.35.8%±3.1%),compared with the intraluminal puncture group(both P<0.05).Besides,the extraluminal puncture group showed a much lower incidence of bone cement leakage(18.8%vs.46.7%)and loosening(0 vs.26.7%,both P<0.05),but similar operation time(min,30.5±7.3 vs.31.3±9.1)and frequency of intraoperative C-arm

关 键 词：Kümmell病 腔隙外穿刺 腔隙内穿刺 经皮椎体成形术 

分 类 号：R687.3[医药卫生—骨科学]