骨填充网袋椎体成形术与经皮球囊后凸成形术治疗骨质疏松性椎体压缩性骨折

目的:探讨骨填充网袋椎体成形术治疗骨质疏松性椎体骨折的临床疗效。方法:对2015年12月至2017年6月符合纳入与排除标准的127例(145椎)骨质疏松性胸腰椎体骨折患者的临床资料进行回顾性分析,通过临床表现、X线、CT、MRI明确责任椎体,其中95例(110椎)采用经皮椎体后凸成形术治疗(PKP组),男34例(42椎),女61例(68椎),年龄(73.92±7.14)岁,胸椎47节(T_8-T_(12)),腰椎63节(L_1-L_5);另外的32例(35椎)采用骨填充网袋椎体成形术治疗(网袋组),男11例(12椎),女21例(23椎),年龄(71.56±7.89)岁,胸椎16节(T_9-T_(12)),腰椎19节(L_1-L_5)。观察患者术后3 d疼痛改善、椎体高度恢复、功能改善情况,并通过X线片观察骨水泥弥散及渗漏情况。结果:所有患者顺利完成手术,术中未出现并发症。骨填充网袋椎体成形术治疗的32例患者手术时间为(31.75±4.99)min,术后3 d的VAS评分,椎体前缘、中部高度,腰部ODI评分分别为(2.38±0.94)分、(19.54±2.36)mm、(18.16±2.65)mm和(25.19±5.49)分,各项目与术前比较明显改善(P0.01),与PKP组比较差异无统计学意义(P0.05)。术后3 d的X线片显示两组患者的骨水泥均呈斑片状、团块状或少量弥散状分布,网袋组的渗漏率为2.86%(1/35),PKP组的渗漏率为16.36%(18/110),多为"拖尾征",两组比较差异有统计学意义(P0.05)。结论:骨填充网袋椎体成形术治疗骨质疏松性椎体骨折具有类似经皮椎体后凸成形术的疗效,能够缓解疼痛,恢复部分椎体高度,并且明显减少渗漏率,是一种简单、快速、有效的治疗方法。

Observation of the clinical efficacy of the bone filling bag vertebroplasty for the treatment of osteoporotic vertebral compression fractures

Objective: To explore the clinical effects of bone filling bag vertebroplasty in treating osteoporotic vertebral compression fractures.Methods: The clinical data of 127 patients (145 vertebrae) with osteoporotic vertebral compression fractures who corresponded the criteria of inclusion and exclusion from December 2015 to June 2017 were retrospectively analyzed. Responsible vertebral bodies were identified by clinical situation, X-rays, CT scan, MRI. Among them, 95 cases (110 vertebrae) were treated by percutaneons kyphoplasty (PKP group), there were 34 males (42 vertebrae) and 61 females (68 vertebrae), with an average age of (73.92±7.14) years, 47 thoracic vertebra (T₈-T₁₂) and 63 lumbar vertebra (L₁-L₅). Other 32 patients (35 vertebrae) were treated by bone filling bag vertebroplasty (bone filling bag vertebroplasty group). There were 11 males (12 vertebrae) and 21 females (23 vertebrae), with an average age of (71.56±7.89) years, 16 thoracic vertebra (T₉-T₁₂) and 19 lumbar vertebra (L₁-L₅). Postoperative pain after 3 days, vertebral body height, improvement of lumbar function were recorded and bone cement diffusion and leakage were observed by X-rays.Results: All operations were successful and no complications were found. In bone filling bag vertebroplasty group, operation time was (31.75±4.99) min, postoperative VAS score at 3 days was (2.38±0.94) points, anterior and middle height of the vertebral body were (19.54±2.36) mm and (18.16±2.65) mm, respectively;ODI score was (25.19±5.49) points, all above items after operation were better than preoperation (P<0.01), but there was no significant difference between two groups (P>0.05). Bone cement was patchy, clumpy or slightly dispersed by X-rays at 3 days after operation, the leakage rate of bone cement in bone filling bag vertebroplasty group was 2.86% (1/35), while was 6.36% (18/110) in PKP group, all of them were "trailing sign", there was significant difference between two groups (P<0.05).Conclusion: The clinical effect of bone filling bag vertebroplasty in the treatment of osteoporotic vertebral compression fractures is similar to percutaneous kyphoplasty, it can effectively relieve the pain, restore part vertebral body height and obviously reduce the leakage rate, with safer, it is a simple, rapid and effective therapeutic method.