单侧多穿刺通道注射骨水泥法在骨质疏松椎体压缩骨折经皮椎体成形术中的应用

目的：探讨经皮椎体成形术中采用单侧多通道穿刺注射骨水泥法的临床价值。方法：自2003年3月至2012年10月，采用单侧经椎弓根穿刺行椎体成形术（PVP）治疗骨质疏松椎体压缩骨折658例（885个椎体），对术中注射骨水泥〈0．3ml即出现骨水泥渗漏的82例（99个椎体）采用单侧多穿刺通道灌注骨水泥，其中男38例（45个椎体），女44例（54个椎体）；年龄69—92岁，平均75．4岁。记录手术时间，骨水泥注入量，并发症，术前及术后1h、1个月、3个月、6个月随访时的疼痛视觉模拟评分（VAS）及术前、术后1个月、3个月、6个月Oswestry功能障碍指数（ODI）以综合评估手术疗效；术后拍摄正侧位x线片，观察骨水泥在椎体内的分布，计算其分布优良率。结果：99个出现骨水泥渗漏的椎体均采用单侧多通道穿刺注射骨水泥法完成PVP操作。平均手术时间为33min，骨水泥分布优良率达98．8％（98／99）；术中无一例出现脊髓、神经根损伤及骨水泥血管内渗漏，无肺栓塞、气胸、穿刺部位出血伤口感染等并发症发生。VAS评分由术前（8．40±0．73）分改善至术后lh的（2．50±0．43）分，术后1个月的（2．00±0．33）分，术后3个月（1．80_＋0．28）分，术后6个月（2．10＋_0．17）分；ODI由术前（40．94±2．72）分改善至术后1个月（9．64±2．60）分，术后3个月（8．52±2．30）分，术后6个月（7．77±2．15）分。术后各时间点VAS评分、ODI与术前比较差异有统计学意义（P〈0．01）。结论：在经皮椎体成形术中发生骨水泥渗漏时，采用单侧多穿刺通道注射骨水泥法骨水泥分布满意、疼痛缓解率高、功能改善明显，无不良事件发生。

Unilateral multiple channels approach in percutaneous vertebroplasty for osteoporotic vertebral fractures

Objective: To explore the therapeutic efficacy of unilateral multiple channels approach in percutaneous vertebroplasty (PVP) for osteoporotic vertebral fractures. Methods: A retrospective review (from March 2003 to October 2012) was conducted on 685 consecutive patients,a total of 885 vertebrae were involved. Eighty-two cases (99 vertebrae) with bone cement leakage when less than 0.3 ml bone cement was injected to fill the fracture were given PVP procedure by unilateral multiple channels approach. 38 cases were male (45 vertebrae) and 44 cases were female (54 vertebrae). The average age was 75.4 years old(from 69 to 92). The operation time,amount of injected bone cement and complications were recorded. Rate of excellent and good outcomes was studied by measuring the cement distribution on the X-ray film. The visual analogue scale (VAS) score and Oswestry disability index (ODI) system were used to evaluate the pain relief and improvement of daily activity function respectively at preoperation and 1 hour,1 month,3 months and 6 months after operation. Results: All these ninety-nine vertebrae were treated in 82 cases with PVP of unilateral multiple channels approach. The average operation time was 33 minutes. The rate of excellent and good outcomes of cement distribution was 98.8%. The VAS score was(8.40±0.73) before surgery,and (2.50±0.43),(2.00±0.33),(1.80±0.28),(2.10±0.17) at 1 hour,1 month,3 months and 6 months respectively after operation. ODI was(40.94±2.72) before surgery,(9.64±2.60) at 1 month after surgery,(8.52±2.30) at 3 months after surgery and (7.77±2.15) at the final follow-up. The differences of the VAS and ODI between pre-operation and post-operation had statistical significance(P<0.01). No spine or nerve injuries occurred intraoperatively. Conclusion: The unilateral multiple channels approach in percutaneous vertebroplasty can obviously relieve the pain and effectively improve the functional activity,provide a satisfied cement distribution in vertebral body with cement leakage after a small amount infusion.