双侧垂直错位穿刺法行经皮椎体成形术治疗单节段轻度骨质疏松性椎体压缩性骨折  

Percutaneous vertebroplasty for treatment of single-level mild osteoporotic vertebral compression fracture by noncoplanar bipedicular puncture method

作　　者：郝国兵 韩振川 庄丽丽 张楠 刘昆 李唐波 宋迪煜 朱泽兴 乔林 Hao Guobing;Han Zhenchuan;Zhuang Lili;Zhang Nan;Liu Kun;Li Tangbo;Song Diyu;Zhu Zexing;Qiao Lin(Department of Orthopaedics,PLA Rocket Force Characteristic Medical Center,Beijing 100088,China)

机构地区：[1]中国人民解放军火箭军特色医学中心骨科,北京100088

出　　处：《脊柱外科杂志》2024年第6期392-398,共7页Journal of Spinal Surgery

摘　　要：目的比较双侧垂直错位穿刺法与双侧水平裂隙穿刺法行经皮椎体成形术(PVP)治疗单节段轻度骨质疏松性椎体压缩性骨折(OVCF)的临床疗效及安全性。方法2019年1月—2022年6月采用PVP治疗单节段轻度OVCF患者75例,其中术中采用双侧垂直错位穿刺法40例(A组),采用双侧水平裂隙穿刺法35例(B组)。记录并比较2组手术时间、骨水泥注入量、骨水泥渗漏率、骨水泥分布分级及并发症发生情况。术前及术后1 d、3个月、6个月采用疼痛视觉模拟量表(VAS)评分评估疼痛程度,采用Oswestry功能障碍指数(ODI)评估腰椎功能,末次随访时采用改良MacNab标准评定手术疗效。在X线片或CT上测量术前及术后1 d、3个月、6个月的伤椎前缘高度及Cobb角。结果所有手术顺利完成,所有患者随访时间>6个月。2组手术时间差异无统计学意义(P>0.05)。A组骨水泥注入量多于B组,骨水泥渗漏率低于B组,骨水泥分布分级良好率高于B组,差异均有统计学意义(P<0.05)。2组患者术后各随访时间点VAS评分、ODI、伤椎前缘高度及Cobb角较术前显著改善,差异均有统计学意义(P<0.05);2组上述指标术后各随访时间点组间差异均无统计学意义(P>0.05)。末次随访时,B组4例患者发生伤椎进一步塌陷,其余患者无并发症发生。A组并发症发生率低于B组,疗效优秀率高于B组,差异均有统计学意义(P<0.05)。结论采用双侧垂直错位穿刺法及双侧水平裂隙穿刺法行PVP均是治疗单节段轻度OVCF的有效方法,且前者在骨水泥渗漏率、骨水泥分布分级、并发症发生率方面更具优势。Objective To compare the clinical efficacy and safety of percutaneous vertebroplasty(PVP)by noncoplanar bipedicular puncture method and coplanar bipedicular puncture method in the treatment of single-level mild osteoporotic vertebral compression fracture(OVCF).Methods From January 2019 to June 2022,75 patients with single-level mild OVCF were treated with PVP,including 40 cases(group A)by noncoplanar bipedicular puncture method and 35(group B)by coplanar bipedicular puncture method.The operation time,bone cement injection volume,leakage rate of bone cement,distribution grading of bone cement and incidence of complications were recorded and compared between the 2 groups.Pain severity was assessed by visual analogue scale(VAS)score at pre-operation and postoperative 1 d,3 months and 6 months.Lumbar function was assessed by Oswestry disability index(ODI).The clinical efficacy was evaluated by the modified MacNab criteria at the final follow-up.The anterior vertebral height and Cobb angle of the injured vertebra were measured on roentgenographs or CTs at pre-operation and at postoperative 1 d,3 months and 6 months.Results All the operations were successfully completed,and all the patients were followed up for more than 6 months.There was no significant difference in operation time between the 2 groups(P>0.05).The bone cement injection volume in group A was higher than that in group B;the leakage rate of bone cement was lower than that in group B;and the good rate of distribution grading of bone cement was higher than that in group B;the differences of the above indexes were statistically significant(P<0.05).The VAS score,ODI,anterior vertebral height and Cobb angle of injured vertebra were significantly improved at each follow-up time point of the 2 groups,all with a statistical significance(P<0.05);and there was no significant difference in the above indexes between the 2 groups at each follow-up time point(P>0.05).At the final follow-up,4 patients in group B experienced further collapse of injured vertebrae,and the

关 键 词：胸椎 腰椎 骨折 压缩性 骨质疏松 骨代用品 椎体成形术 

分 类 号：R683.2[医药卫生—骨科学]