倒退旋转法穿刺技术在经皮球囊扩张椎体后凸成形术中的应用

目的:探讨倒退旋转法穿刺技术辅助的经皮球囊扩张椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCFs)患者的临床疗效。方法:回顾性分析2015年1月至2016年12月采取经皮穿刺球囊撑开扩张椎体后凸成形术穿刺位置不良的100例OVCFs患者,均为单节段骨折,受伤或出现明显腰痛时间1个月,伴有局部压痛、叩击痛,胸腰部活动受限。根据术中穿刺方法的不同分为倒退旋转法穿刺组及传统穿刺组,每组各50例。分析两组的手术时间、放射透视次数、手术并发症和手术前后的视觉模拟评分(visual analogue scale,VAS)评价手术效果。结果:100例患者均完成手术,术后随访均超过1年。倒退旋转法穿刺组手术时间(21.5±5.9) min,术中穿刺C形臂X线透视(7.7±1.3)次,每椎骨水泥注入量(4.6±0.8) ml;术前VAS评分为8.3±0.9,术后1年为2.3±0.8。传统穿刺组手术时间(30.2±7.5) min,术中穿刺C形臂X线透视(14.3±2.0)次,骨水泥注入量(4.3±1.0) ml;术前VAS评分为8.1±1.0,术后1年为2.6±0.5。两组骨水泥注入量及术后1年的VAS评分差异无统计学意义(P0.05),而两组手术时间及术中穿刺C形臂X线透视次数差异有统计学意义(P0.05)。结论:在PKP手术中对于首次穿刺位置不良者,运用倒退旋转法穿刺技术可以快速改变穿刺针的进针点和进针方向,达到理想穿刺靶点,可减少手术时间和术中X线透视次数。

Application of backward-rotation puncture technique in percutaneous kyphoplasty

Objective: To investigate the clinical effect of backward-rotation puncture technique in the course of percutaneous kyphoplasty (PKP) in patients with osteoporotic vertebral compression fractures (OVCFs).Methods: The clinical data of 100 patients with OVCFs who had a poor puncture position by percutaneous kyphoplasty from January 2015 to December 2016 were retrospectively analyzed. All patients were single vertebral compression fracture,whose trauma history or obvious low back pain was less than 1 month,with local tenderness,percussion pain,and limited thoracolumbar movement. According to the different puncture methods,the patients were divided into backward-rotation puncture group and traditional puncture group,50 patients in each group. Operation time,X-ray exposure times,surgical complications,pre-and post-operative visual analogue scale (VAS) were analyzed.Results: All 100 patients underwent the operation and were followed up for more than 1 year. In backward-rotation puncture group,operation time was (21.5±5.9) min,X-ray exposure was (7.7±1.3) times,and bone-cement injection volume was (4.6±0.8) ml,VAS score was decreased from 8.3±0.9 to 2.3±0.8 at 1 year after operation. In traditional puncture group,operation time was (30.2±7.5) min,X-ray exposure was (14.3±2.0) times,and bone-cement injection volume was (4.3±1.0) ml,VAS score was decreased from 8.1±1.0 to 2.6±0.5 at 1 year after operation. There were no statistical differences in bone-cement injection volume and VAS at 1 year after operation between two groups (P>0.05). There were statistical differences in operation time and X-ray exposure times between two groups (P<0.05).Conclusion: The application of backward-rotation methods can quickly adjust entry points and trajectories of the needle with poor puncture position during percutaneous kyphonplasty,and it can reduce operation time and intraoperative X-ray exposure times.