网格定位器在腰椎椎体成形术中的应用

目的比较网格优化椎体成形术(percutaneous vertebroplasty,PVP)与传统PVP治疗骨质疏松性椎体压缩骨折的疗效。方法回顾性分析2016年5月至2019年5月北部战区总医院脊柱外科收治196例腰椎单节段行PVP治疗患者的临床资料,根据手术方法不同分为网格优化组(102例)和传统PVP组(94例)。网格优化组:男38例、女64例,年龄(67.3±8.5)岁,病程(2.3±1.2)d,L1椎体59例、L2椎体31例、L3椎体8例、L4椎体3例、L5椎体1例。传统PVP组:男26例、女68例,年龄(71.5±5.6)岁,病程(2.1±1.1)d,L1椎体52例、L2椎体33例、L3椎体7例、L4椎体2例。术前按两组不同方法选择最佳穿刺点及穿刺角度,完成穿刺后置入导丝及工作通道,推入骨水泥,术毕。主要观察指标为手术时间、术中X线透视次数、骨水泥注入量、骨水泥渗漏情况,以及疼痛视觉模拟评分(visual analogue scale,VAS)、伤椎前缘和伤椎中缘高度。结果两组患者术前一般资料的差异均无统计学意义(P>0.05),证明两组患者的基线资料具有可比性。所有患者均顺利完成手术,术中、术后均未出现脊髓神经损伤、切口感染、肺栓塞、死亡等严重并发症。网格优化组患者手术时间(34.8±6.5)min、透视次数(29.5±5.5)次、骨水泥注入量(5.3±2.1)ml、骨水泥渗透率3.9%(4/98)均优于传统PVP组,差异均有统计学意义(P<0.05)。网格优化组术后第3天、3个月及末次随访时VAS评分分别为(1.1±0.6)分、(1.0±0.3)分和(0.9±0.2)分,均优于传统PVP组(P<0.05)。两组患者术后第3天伤椎前缘及中缘高度的差异均无统计学意义(P>0.05),但网格优化组术后3个月伤椎前缘和中缘高度分别为(1.8±0.4)mm、(1.8±0.3)mm,末次随访时分别为(1.7±0.3)mm、(1.7±0.3)mm,均优于传统PVP组,差异均有统计学意义(P<0.05)。结论相比传统PVP手术,术前应用网格定位器进行网格优化PVP手术治疗骨质疏松性椎体压缩骨折更安全、有效。

The application of grid locator in lumbar vertebroplasty

Objective To compare the optimal gridpercutaneous vertebroplasty(PVP)and conventional PVP in the treatment of osteoporotic vertebral compression fractures(OVCFs).Methods A retrospective cohort study was conducted of 102 patients with OVCFs who had underwent PVP between May 2016 and May 2019 at department of spine surgery,General Hospital of Northern Theater Command.According to the different surgical methods,they were divided into the optimalgrid PVP group(102 cases)and conventional PVP group(94 cases).In the optimal grid PVP group,there were 38 males and 64 females with an average age of 67.3±8.5 years old,and the course of disease was 2.3±1.2 days;the injured sites were lumbar vertebra,including 59 cases of L1 vertebra,31 cases of L2 vertebra,8 cases of L3 vertebra,3 cases of L4 vertebra and 1 case of L5 vertebra.In the conventional PVP group,there were 26 males and 68 females with an average age of 71.5±5.6 years old,and the course of disease was 2.1±1.1 days;the injured sites were lumbar vertebra,including 52 cases of L1 vertebra,33 cases of L2 vertebra,7 cases of L3 vertebra and 2 cases of L 4 vertebra.The patients were prepared before operation.Then the best puncture point was selected,and the guide wire and working channel were inserted.Finally the bone cement was pushed.The operation time,intraoperative fluoroscopy times,bone cement dosage and bone cement leakage were compared between the two groups.Visual analogue scale(VAS),anterior heights and median heights of injured vertebra were compared between the two groups at postoperative 3 days,3 months and the final follow-up.Results There were no significant differences in the general clinical data between the two groups before operation(P>0.05).All patients had no complications such as wound infection,pulmonary embolism,spinal cord embolism or death.The operation time,fluoroscopy times,bone cement dosage and bone cement permeability of the two groups were statistically significant different(P<0.05),and the optimal grid group was better than the conventional group.VAS at 3 days,3 months and the final follow-up was statistically significantlower in the optimal grid group than the conventional group(P<0.05).There was no significant difference in the recovery of the anterior and middle edge heights of injured vertebra in the two groups 3 days after operation(P>0.05),but there were statistical significant difference between the two groups3 months after operation and at the last follow-up(P<0.05),whilethe optimal grid group was better than the conventional group.Conclusion Compared with conventional PVP,the optimal grid PVP is safer and more effective in the treatment of osteoporotic vertebral compression fractures.