可弯曲骨水泥输送器不同穿刺方式治疗骨质疏松性椎体上1/3压缩性骨折的疗效比较  

Comparative study on effectiveness of different puncture methods of flexible bone cement delivery device in treatment of osteoporotic vertebral upper 1/3 compression fractures

作　　者：李唐波 刘昆 张楠 郝国兵 朱泽兴 乔林 宋迪煜 LI Tangbo;LIU Kun;ZHANG Nan;HAO Guobing;ZHU Zexing;QIAO Lin;SONG Diyu(Department of Orthopedics,Chinese PLA Rocket Force Characteristic Medical Center,Beijing,100088,P.R.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：《中国修复重建外科杂志》2025年第4期470-477,共8页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探究单侧经皮弯角椎体成形术治疗骨质疏松性椎体上1/3压缩性骨折中,可弯曲骨水泥输送器不同穿刺方式的临床疗效。方法回顾性分析2023年1月—2024年4月收治且符合选择标准的67例骨质疏松性椎体上1/3压缩性骨折患者临床资料。根据术中可弯曲骨水泥输送器穿刺方式,分为斜行穿刺组(37例)、平行穿刺组(30例)。两组患者性别、年龄、骨密度T值、骨折节段分布、受伤至手术时间以及术前疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、伤椎前缘高度、伤椎Cobb角差异均无统计学意义(P>0.05)。比较两组手术时间、二次穿刺发生率、骨水泥渗漏发生率、骨水泥注射量、骨水泥弥散分布评分,以及术后1 d及末次随访时VAS评分、ODI、伤椎前缘高度和伤椎Cobb角。结果术中斜行穿刺组2例、平行穿刺组7例行二次补充穿刺,二次穿刺率差异有统计学意义(P<0.05)。两组均未发生骨水泥过敏、骨水泥栓塞、神经损伤及硬膜外血肿等并发症。两组手术时间、骨水泥注射量、骨水泥渗漏发生率及骨水泥分布评分、评级差异均无统计学意义(P>0.05)。患者均获随访,随访时间6~18个月,平均12.0个月,随访时间组间差异无统计学意义(P>0.05)。随访期间伤椎无再次骨折塌陷压缩。两组患者术后1 d及末次随访时VAS评分、ODI以及伤椎前缘高度、伤椎Cobb角均优于术前,差异有统计学意义(P<0.05);术后两时间点间差异亦有统计学意义(P<0.05)。上述指标两组间各时间点差异均无统计学意义(P>0.05)。结论单侧经皮弯角椎体成形术治疗骨质疏松性椎体上1/3压缩骨折时,可弯曲骨水泥输送器采用斜行或平行穿刺方式均能有效缓解疼痛,但前者有利于减少术中二次穿刺发生率。Objective To compare the effectiveness of different puncture methods of the flexible bone cement delivery device in unilateral percutaneous curved vertebroplasty for osteoporotic vertebral upper 1/3 compression fractures.Methods A retrospective analysis was conducted on the clinical data of 67 patients with osteoporotic vertebral upper 1/3 compression fractures who were admitted and met the selection criteria between January 2023 and April 2024.The patients were divided into two groups based on the puncture method of the flexible bone cement delivery device:the oblique puncture group(n=37)and the parallel puncture group(n=30).There was no significant difference(P>0.05)between the two groups in terms of gender,age,bone mineral density(T value),distribution of fractured vertebrae,time from injury to operation,and preoperative visual analogue scale(VAS)score for pain,Oswestry disability index(ODI),anterior vertebral height of the fractured vertebra,and Cobb angle of the fractured vertebra.The following parameters were compared between the two groups:operation time,incidence of secondary puncture,incidence of bone cement leakage,volume of injected bone cement,bone cement distribution score,as well as VAS score,ODI,anterior vertebral height of the fractured vertebra,and Cobb angle of the fractured vertebra at 1 day after operation and at last follow-up.Results Two cases in the oblique puncture group and 7 cases in the parallel puncture group underwent secondary puncture during operation,and the difference in the incidence of secondary puncture was significant(P<0.05).No complications such as bone cement hypersensitivity,bone cement embolism,nerve injury,or epidural hematoma occurred in both groups.There was no significant difference in operation time,volume of injected bone cement,incidence of bone cement leakage,distribution score and rating of bone cement between the two groups(P>0.05).All patients were followed up 6-18 months(mean,12.0 months),and there was no significant difference in the follow-up time between th

关 键 词：经皮弯角椎体成形术 骨质疏松性椎体压缩性骨折 椎体上1/3骨折 可弯曲骨水泥输送器 穿刺方式 

分 类 号：R687.3[医药卫生—骨科学]