后外上方单侧穿刺椎体成形术治疗骨质疏松椎体压缩骨折的安全性及有效性

目的 评估后外上方入路单侧穿刺行椎体成形术(PVP)治疗骨质疏松性椎体压缩骨折(OVCF)的安全性和有效性。方法 回顾性分析自2017年9月至2018年9月本科收治的109例(144个椎体)骨质疏松性椎体压缩骨折患者资料,平均年龄(76.7±9.9)岁(55～96岁),采用后外上方单侧穿刺入路行椎体成形术进行治疗。记录手术时间、注入的骨水泥体积、并发症发生率、视觉疼痛模拟量表(VAS)、Oswestry残疾指数(ODI)评分、穿刺针尖端的最终位置以及聚甲基丙烯酸甲酯(PMMA)骨水泥在椎体中的扩散。结果 所有患者均成功完成手术,平均随访(9.1±2.9)个月。每个骨折椎体的平均手术时间为(24.0±3.5) min。注入骨水泥的平均体积为(4.8±0.6) m L。术前平均VAS评分为(8.4±0.7)分,术后1 d为(1.6±0.6)分,末次随访为(1.2±0.6)分。术前ODI平均得分为(70.97±7.73)分,术后1 d为(27.99±4.12)分,末次随访为(19.65±3.49)分。穿刺针尖端的最终位置:119根穿刺针到达中线,15根接近中线,10根超过中线。骨水泥在椎体中的分布类型:81例为类型1(56.3%),37例为类型2(25.7%),18例为类型3(12.5%),8例为类型5(5.5%),无病例为类型4。1例术后出现气胸,无其他并发症(如血肿、骨水泥栓塞、脊髓及神经损伤)。结论 椎体后外上方入路单侧穿刺的椎体成形术,可较为方便地穿刺至椎体中线,获得良好的骨水泥弥散,是治疗骨质疏松椎体压缩骨折的一种安全、有效方法。

Safety and efficacy of unilateral percutaneous vertebroplasty for the treatment of osteoporotic vertebral compression fractures

Objective To evaluate the safety and efficacy of percutaneous vertebroplasty(PVP) for the treatment of osteoporotic vertebral compression fractures (OVCF) with unilateral puncture of the posterior vertebral body. Methods Retrospective analysis during the period from September 2017 to September 2018 was conducted, there were 109 patients (144 vertebral bodies) with osteoporotic vertebral compression fractures, with an average age of (76.7±9.9) years (55-96 years). They underwent PVP with one-sided puncture of the posterior superior approach. The operation time, the volume of bone cement injected, the incidence of complications, the visual analog scale(VAS) , the Oswestry disability index (ODI) score, the final position of the tip of the needle, and the spread of polymethyl methacrylate (PMMA) in the vertebral body were recorded. Results All patients had been completed the operation successfully and were followed up (9.1±2.9) months. The average operation time of each VB was (24.0±3.5) min. The average volume of cement was (4.8±0.6) mL. The mean VAS scores were (8.4±0.7) preoperatively, (1.6±0.6) at the first day postoperatively, and (1.2±0.6) at the last follow-up. The mean ODI scores were (70.97±7.73) preoperatively, (27.99±4.12) at the first day postoperatively, and (19.65±3.49) at the last follow-up. The position of puncture needles in the VB was: 119 vertebral puncture needles reached the midline, 15 were close to the midline, and 10 exceeded the midline. The spread of PMMA in the VB was: type 1 in 81(56.3%), type 2 in 37 (25.7%), type 3 in 18 (12.5%), type 5 in 8 (5.5%), and no case in type 4. One case developed pneumothorax after operation. No other complications (hematoma, cement embolism, spinal cord, and nerve injury) occurred. Conclusion Vertebroplasty with unilateral puncture of the anterior and posterior vertebral body can be easily punctured to the midline of the vertebral body to obtain good bone cement dispersion, which is a safe and effective method for the treatment of osteoporotic vertebral compression fractures.