骨质疏松性椎体压缩骨折经皮椎体成形术中应用斜面外套管的临床效果分析  

Clinical outcomes of oblique-opening cannula in percutaneous vertebroplasty for osteoporotic vertebral compression fracture

作　　者：王永杰[1] 王彦辉[1] 袁鑫[1] 刘亚东[1] 崔利宾[1] 路茜[1] 陈学明[1] WANG Yongjie;WANG Yanhui;YUAN Xin;LIU Yadong;CUI Libin;LU Qian;CHEN Xueming(Department of Spinal Surgery,Beijing Luhe Hospital,Capital Medical University,Beijing 101149,China)

机构地区：[1]首都医科大学附属北京潞河医院脊柱外科,北京101149

出　　处：《中华骨与关节外科杂志》2024年第7期597-603,共7页Chinese Journal of Bone and Joint Surgery

基　　金：北京市通州区科技计划项目(KJ2023CX032)。

摘　　要：目的:与应用传统平面外套管对比,分析骨质疏松性椎体压缩骨折(OVCF)经皮椎体成形术(PVP)中应用斜面外套管的临床效果。方法:回顾性分析2020年1月至2022年6月首都医科大学附属北京潞河医院189例接受PVP治疗的OVCF患者的临床资料。其中95例患者术中使用斜面外套管(斜面外套管组),94例患者术中使用平面外套管(平面外套管组)。术后第1天行CT检查,观察两组患者骨水泥渗漏及弥散情况。比较两组患者手术时间、骨水泥注入量和住院时间,以及术前、术后1 d及术后6个月疼痛视觉模拟评分(VAS)。采用多因素logistic回归分析对骨水泥渗漏的影响因素进行分析。结果:斜面外套管组患者骨水泥皮质性渗漏率为13.7%(13/95),静脉性渗漏率为12.6%(12/95),均低于平面外套管组患者的24.5%(23/94)和51.1%(48/94)(P均<0.05)。斜面外套管组患者骨水泥弥散良好率为82.1%(78/95),优于平面外套管组患者的69.1%(65/94)(P<0.05)。斜面外套管组患者手术时间少于平面外套管组患者(P<0.05);而两组患者骨水泥注入量、住院时间,以及术前、术后1d及术后6个月VAS评分差异均无统计学意义(P均>0.05)。多因素logistic回归分析结果显示,术中应用斜面外套管[比值比(OR)=0.173,95%置信区间(95%CI):0.068~0.439,P=0.000]和轻度骨折(OR=0.176,95%CI:0.066~0.475,P=0.001)是骨水泥皮质性渗漏发生的保护性因素;存在骨皮质破裂(OR=5.294,95%CI:1.094~25.617,P=0.038)是骨水泥皮质性渗漏发生的独立危险因素;术中应用斜面外套管(OR=0.068,95%CI:0.029~0.159,P=0.000)是骨水泥静脉性渗漏发生的保护因素,性别为男性(OR=2.701,95%CI:1.071~6.817,P=0.035)是骨水泥静脉性渗漏发生的独立危险因素。结论:OVCF PVP术中应用斜面外套管能够更有效地降低骨水泥渗漏的发生率,并且能够达到更好的骨水泥弥散效果。Objective:To compare the clinical outcomes of oblique-opening cannula with traditional flat-opening cannula during percutaneous vertebroplasty(PVP)for osteoporotic vertebral compression fracture(OVCF).Methods:A retrospective analysis was conducted on the clinical data from 189 OVCF patients who underwent PVP from January 2020 to June 2022 in Beijing Luhe Hospital,Capital Medical University.Among them,95 patients were treated with an oblique-opening cannula(oblique-opening cannula group),and 94 patients were treated with a flat-opening cannula(flat-opening cannula group).Postoperative computed tomography scans were performed on the first day to observe bone cement leakage and dispersion within the vertebrae in both groups.The operation time,bone cement volume,length of hospital stay,and visual analog scale(VAS)pain scores before surgery,one day post-surgery,and six months post-surgery were compared between the two groups.Multinomial logistic regression analysis was conducted to identify factors affecting bone cement leakage.Results:The oblique-opening cannula group showed significantly lower rates of cortical(13.7%[13/95])and venous(12.6%[12/95])bone cement leakage compared to the flat-opening cannula group(24.5%[23/94]and 51.5%[48/94],respectively;both P<0.05).The dispersion of bone cement in the oblique-opening cannula group(82.1%[78/95])was also superior compared to the flat-opening cannula group(69.1%[65/94];P<0.05).The operation time in the oblique-opening cannula group was shorter than that in the flat-opening cannula group(P<0.05).There were no statistically significant differences in bone cement volume,length of hospital stay,and VAS score at the specified times between the two groups(all P>0.05).Multinomial logistic regression analysis identified that the use of oblique-opening cannula(odds ratio[OR]=0.173,95%confidence interval[95%CI]:0.068-0.439,P=0.000)and mild-fracture(OR=0.176,95%CI:0.066-0.475,P=0.001)were protective factors against cortical leakage of bone cement,while cortical bone rupture(OR=5.29

关 键 词：斜面外套管 骨水泥渗漏 椎体成形术 骨质疏松性椎体压缩骨折 

分 类 号：R683.2[医药卫生—骨科学]