双侧椎弓根入路低温生理盐水椎体灌洗抽吸术在经皮椎体成形术中应用的临床观察  

Clinical Observation of Applying Bilateral Pedicular Approach Combined with Low-Temperature Physiological Saline Irrigation in Percutaneous Vertebroplasty

作　　者：郑圣安 郑丰裕 ZHENG Sheng-an;ZHENG Feng-yu(Orthopedics,Beijing Royal Integrative Medicine Hospital,Beijing 102209,China)

机构地区：[1]北京王府中西医结合医院骨科,北京102209

出　　处：《伤害医学(电子版)》2024年第4期47-53,共7页Injury Medicine(Electronic Edition)

摘　　要：目的观察双侧椎弓根入路低温生理盐水椎体灌洗抽吸术在经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)术中的应用价值。方法回顾性研究2020年10月至2022年08月间因OVCF入院行经皮椎体成形术的102例(143个椎体)患者,男27例,女75例;年龄61~92岁,平均年龄(77.58±7.82)岁。根据术中不同操作方式分为对照组和实验组。对照组:非生理盐水椎体灌洗抽吸经皮椎体成形组;实验组:经皮椎体成形术联合低温生理盐水椎体灌洗抽吸组。对照组40例(59椎);实验组62例(84椎)。比较两组患者的临床资料,包括年龄、性别、病程、伤椎分布、骨密度(bone mineral density,BMD)T值、术前及术后视觉模拟评分法(visual analogue scale,VAS)评分、手术时间、椎体压缩程度、骨水泥渗漏相关危险因素、单椎体骨水泥注入量、骨水泥分布-Ⅰ型比例、骨水泥渗漏率和血管相关渗漏率等指标。结果102例患者顺利完成手术。术后随访12~26个月,平均(14.12±6.46)个月。两组年龄、性别、病程、BMD T值、手术时间、单椎体骨水泥注入量均无统计学差异(PALL>0.05);两组术后VAS评分均低于术前(P<0.05);实验组骨水泥分布-I型比例明显高于对照组(P<0.05)。骨水泥渗漏总发生率21.7%,对照组28.6%(24个椎体),实验组11.9%(7个椎体),两组比较差异有统计学意义(P<0.05);血管相关渗漏总发生率14.7%,对照组21.4%(18个椎体),实验组5.1%(3个椎体),两组比较差异有统计学意义(P<0.05)结论双侧椎弓根入路低温生理盐水椎体灌洗抽吸术应用于PVP治疗OVCF患者,有利骨水泥弥散,可明显降低骨水泥渗漏,尤其是血管相关渗漏风险。Objective This study aimed to investigate the clinical value of applying bilateral pedicular approach combined with low-temperature physiological saline irrigation in percutaneous vertebroplasty(PVP)for the treatment of osteoporotic vertebral compression fractures(OVCF).Methods Clinical data of 102 cases(143 vertebrae)who suffered from OVCF and undergone PVP(from October 2020 to August 2022)were investigated retrospectively.There were 27 male and 75 female,with a mean age of 77.58±7.82 years old.The cases were divided into two groups:control with 40 cases(59 vertebrae)treated with regular PVP during cement augmentation,and experiment with 62 cases(84 vertebrae)treated with bilateral pedicle approach and low-temperature physiological saline irrigation before cement augmentation.Clinical data including age,gender,duration of injury,distribution of injured vertebra,bone mineral density(BMD)T-score,preoperative and postoperative visual analogue scale(VAS)scores,operative time,ration of vertebral compression,factors related to cement leakage,volume of single vertebra cement argumentation,typeⅠcement distribution,total cement leakage,and vascular leakage were compared between two groups.Results The follow-up period was 12-26 months,with a mean of(14.12±6.46)months.Between the two groups,there were no significant differences in age,gender,duration of injury,BMD T-score,operative time,and volume of single vertebra cement argumentation(P_(ALL)>0.05).The postoperative VAS scores in both groups were significantly lower than those preoperatively(P<0.05).The ratio of typeⅠcement distribution was significantly higher in the experiment group than that in the control group(P<0.05).The incidence of total cement leakage was 21.7%,which was significantly lower in the experiment group(11.9%)than that in the control group(28.6%)(P<0.05).The incidence of vascular leakage was 14.7%,which also was significantly lower in the experiment group(5.1%)than that in the control group(21.4%)(P<0.05).Conclusion Our data shows that applying

关 键 词：骨质疏松性椎体压缩骨折 经皮椎体成形术 骨水泥渗漏 低温生理盐水 灌洗 

分 类 号：R687.3[医药卫生—骨科学]