经Kambin三角穿刺椎体成形治疗骨质疏松压缩性骨折:安全性和有效性评价  

Percutaneous vertebroplasty via Kambin's triangle for treatment of osteoporotic compression fractures:evaluation of safety and effectiveness

作　　者：江泽华[1] 杜文君[1] 任志帅 崔皓竣 朱如森[1] Jiang Zehua;Du Wenjun;Ren Zhishuai;Cui Haojun;Zhu Rusen(Department of Spine Surgery,Tianjin Union Medical Center,Tianjin 300121,China)

机构地区：[1]天津市人民医院脊柱外科,天津市300121

出　　处：《中国组织工程研究》2025年第33期7181-7188,共8页Chinese Journal of Tissue Engineering Research

基　　金：天津市人民医院院级科研基金(2019JZPY08),项目负责人:江泽华;天津市卫生健康委员会科技项目青年项目(TJWJ2022QN040),项目负责人:任志帅。

摘　　要：背景:目前腰椎压缩骨折手术治疗的主要目的是改善症状、减少疼痛、提高生活质量,在最大限度内降低手术风险,减少手术暴露时间。目的:探讨经Kambin三角穿刺椎体成形治疗老年性脊柱畸形合并骨质疏松椎体压缩性骨折患者的安全性及有效性。方法:回顾性分析天津市人民医院2019年1月至2022年12月收治的脊柱畸形合并骨质疏松椎体压缩性骨折患者31例,其中男21例,女10例;年龄60-84(70.0±10.3)岁;病程1-6(3.5±1.7)周;共有35个病变的节段椎体。压缩骨折椎体范围:L_(1)骨折10例、L_(2)骨折12例、L_(1)+L_(2)骨折2例、L_(3)骨折5例、L_(1)+L_(3)骨折2例。根据入路方式分为2组:A组(经Kambin三角入路行椎体成形)15例,B组(经传统椎弓根穿刺行椎体成形)16例,两组患者均行单侧入路椎体成形术。记录两组患者的手术时间、射线暴露次数,明确有无骨水泥渗漏,是否出现神经及血管损伤等并发症,术后CT观察骨水泥弥散及硬化的情况。结果与结论:①A组手术时间21-30 min/椎,平均(25.0±5.7)min;B组手术时间25-43 min/椎,平均(33.0±7.2)min;单个椎体穿刺时间B组要长于A组,差异有显著性意义(P<0.05);②A组每个椎体术中平均射线暴露次数(6.2±1.6)次,B组每个椎体术中平均射线暴露次数为(9.3±1.8)次,两组比较差异有显著性意义(P<0.05);③A组未发现骨水泥渗漏,B组出现2例骨水泥渗漏,其中1例椎管内少量渗漏,未出现明显神经症状,渗漏率为13%;两组均出现1例皮下血肿;④术后CT观察骨水泥在椎体中的分布情况,A、B组骨水泥能在椎体中均匀扩散的分布率分别为71%和33%,两组比较差异有显著性意义(P<0.05);⑤提示经Kambin三角入路穿刺行经皮椎体成形治疗的手术时间短,骨水泥在椎体内弥散分布填充好,并发症的风险发生率低,辐射暴露量少,单侧穿刺就能达到满意的效果。BACKGROUND:Currently,the main purpose of surgical treatment for lumbar compression fractures is to improve symptoms,reduce pain,improve quality of life,minimize surgical risks,and reduce surgical exposure time.OBJECTIVE:To explore the safety and clinical efficacy of percutaneous vertebroplasty via Kambin’s triangle in the treatment of senile spinal deformity accompanied by osteoporotic vertebral compression fractures.METHODS:A retrospective analysis was conducted on 31 patients with spinal deformity and osteoporotic vertebral compression fractures who were admitted to Tianjin Union Medical Center from January 2019 to December 2022.There were 21 males and 10 females,aged between 60 and 84(70.0±10.3)years old.The duration of illness ranged from 1 to 6(3.5±1.7)weeks.A total of 35 vertebral segments were affected.The distribution of vertebral compression fractures included:10 cases of L_(1)fracture,12 cases of L_(2)fracture,2 cases of L_(1)+L_(2)fracture,5 cases of L_(3)fracture,and 2 cases of L_(1)+L_(3)fracture.Based on the surgical approach,patients were divided into two groups:group A(via Kambin’s triangle approach)with 15 cases,and group B(via traditional pedicle puncture)with 16 cases.Unilateral approach vertebroplasty was performed on both groups.The surgical duration,number of radiation exposures,presence of bone cement leakage,occurrence of complications such as nerve and vascular injuries were recorded in both groups.Postoperative CT scans were used to observe the dispersion and hardening of bone cement.RESULTS AND CONCLUSION:(1)In the group A,the surgical duration was 21-30 minutes per vertebra,with an average of(25.0±5.7)minutes.In the group B,the surgical duration was 25-43 minutes per vertebra,with an average of(33.0±7.2)minutes.The surgical duration for puncturing a single vertebra was significantly longer in the group B compared to the group A,with a statistically significant difference(P<0.05).(2)The average number of radiation exposures per vertebra during surgery was(6.2±1.6)in the group A

关 键 词：骨质疏松压缩骨折 Kambin三角 椎体成形术 临床疗效 并发症 骨科植入物 脊柱植入物 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R687