液压输送式椎体成形术对椎体形态及骨水泥弥散影响的研究

目的:评价不同骨水泥输送装置经皮椎体成形术(percutaneous vertebroplasty,PVP)对椎体形态及骨水泥填充弥散的影响。方法:对2016年1月至2017年12月收治的52例单节段骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCFs)进行回顾性分析。根据手术中骨水泥注入方法的不同将52例患者分为液压组(28例)和推杆组(24例)。比较两组患者手术前后VAS评分,观察手术前后病椎椎体前缘高度、椎体压缩比、后凸角,分析术后侧位椎体前1/3、中线、后1/3骨水泥填充比和正位X线片中骨水泥弥散情况,评价不同骨水泥输送装置PVP术后对椎体形态及骨水泥弥散可能产生的影响。结果:所有患者术后VAS评分较术前明显改善,液压组优于推杆组(P0.05)。椎体前缘高度、椎体压缩比及后凸角较术前均有明显恢复(P0.05),组间比较差异无统计学意义(P0.05)。侧位X线片骨水泥填充比,两组在椎体前1/3及中线处差异无统计学意义(P0.05),但在椎体后1/3处差异明显(P0.05);正位X线片上液压组骨水泥弥散更加显著(P0.05)。结论:液压式PVP术具有更佳的临床疗效,能保证骨水泥在骨折椎体内充分填充,能更好地恢复椎体形态,是一种有效的新技术,值得在临床推广应用。

Study on the effect of hydraulic delivery vertebroplasty on vertebral morphology and bone cement diffusion

Objective:To evaluate the effect of different bone cement injection methods during percutaneous vertebroplasty(PVP) on vertebral morphology and cement diffusion.

Methods:The clinical data of 52 patients with single-segment osteoporotic vertebral compression fracture treated from January 2016 to December 2017 were retrospectively analyzed. The patients were divided into hydraumatic group (28 cases) and pusher group (24 cases) according to bone cement injection method during PVP. By comparing visual analogue scale(VAS),height of anterior vertebral body,compression ratio,kyphosis angle before and after operation and analyzing filling ratio of bone cement in the first 1/3,median line and back 1/3 of the vertebral body in lateral X-rays and the conditions of bone cement diffusion in AP X-rays were to evaluate the effect of different bone cement injection methods on vertebral morphology and cement diffusion.

Results:Postoperative VAS was obviously improved in all patients and hydraumatic group was better than pusher group(P<0.05). Postoperative height of anterior vertebral body,compression ratio and kyphosis angle obviously restored in all patients while there was no significant difference between two groups(P>0.05). There was no significant difference in filling ratio of bone cement in the first 1/3 and median line of the vertebral body by lateral X-ray films between two groups(P>0.05),but in the back 1/3 of the vertebral body filling ratio of bone cement in hydraumatic group was better than in pusher group(P<0.05). The distribution of bone cement from AP X-ray films were more significant in hydraumatic group(P<0.05).

Conclusion:Hydraulic delivery vertebroplasty (HDVP) has better clinical efficacy and it can guarantee sufficient distribution of bone cement into the fractured vertebra and preferably restore the morphology of vertebral body,which is worthy of clinical application.