PKP术中应用低温间断灌注技术治疗周壁破裂型OVCF

目的通过与温度梯度灌注技术进行比较,探讨低温间断灌注技术在经皮椎体后凸成形术治疗椎体周壁破裂型骨质疏松性骨折中的临床价值。方法回顾性分析我院2015年1月至2018年12月期间共60例周壁破损型骨质疏松性椎体骨折患者,均为单椎体骨折,根据骨水泥灌注方法的不同分为温度梯度灌注组30例和低温间断灌注组30例。温度梯度灌注组男6例,女24例;平均年龄为(71.9±6.9)岁;低温间断灌注组男8例,女22例;平均年龄(69.7±7.2)岁。比较两组术前、术后2 d及末次随访时疼痛视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(Oswestry disability index,ODI),椎体后凸角,伤椎椎体前缘相对高度,手术时间,骨水泥注射量,骨水泥分布面积比,骨水泥可推注时间(从开始推注到所有骨水泥至团块期晚期不可推注的时间),骨水泥渗漏率。结果温度梯度灌注组术后随访时间平均(15.3±8.4)个月;低温间断灌注组术后随访时间平均(18.6±8.2)个月,两组间比较差异无统计学意义(P>0.05)。两组内术后2 d和末次随访时VAS评分、ODI评分较术前差异均有统计学意义(P<0.05),两组内末次随访时与术后2d相比差异无统计学意义(P>0.05)。术后2 d和末次随访时,两组组间的VAS评分比较差异有统计学意义(P<0.05),其余时间点VAS评分和ODI比较差异无统计学意义(P>0.05)。手术前后及末次随访时,两组组间的伤椎前缘相对高度和伤椎椎体后凸角比较差异均无统计学意义(P>0.05)。两组间手术时间差异无统计学意义(P>0.05),其中低温间断灌注组的骨水泥可推注时间(12.1±1.0)min,显著长于温度梯度灌注组(5.3±1.1)min(P<0.05)。低温间断灌注组的骨水泥灌注量(3.9±0.79)mL,骨水泥分布面积比(0.46±0.10),均优于温度梯度灌注组(3.20±0.67)mL和(0.31±0.07),差异有统计学意义(P<0.05)。低温间断灌注组有2例患者发生骨水泥渗漏,渗漏率6.7%,显著低于温度梯度灌注组的骨水泥渗漏率26.7%(P<0.05)。结论低温间断灌注技术可以有效延长骨水泥可推注时间,有利于提高骨水泥在椎体内的注射量和分布面积,降低骨水泥渗漏率的同时可获得更好的临床疗效。

Application of Low-temperature Intermittent Cement Injection Technique in the Treatment of Osteoporotic Vertebral Compression Fracture with Peripheral Wall Damage by Percutaneous Kyphoplasty

Objective To explore the clinical efficacy of Low-temperature intermittent cement injection technique in the treatment of osteoporotic vertebral compression fracture with peripheral wall damage by percutaneous kyphoplasty(PKP)by comparing with temperature gradient cement injection technique.Methods A total of 60 patients,all of which were single vertebral fractures with osteoporotic vertebral fracture and peripheral wall damage from Jan.2015 to Dec.2018 were reviewed.According to the different methods of cement injection technique,the patients were divided into temperature gradient cement injection technique group and Low-temperature intermittent cement injection technique group,both groups included 30 patients separately.Outcomes were evaluated pre-and postoperative by using visual analogue score(VAS),Oswestry disability index(ODI),the local kyphosis angle,the anterior relative vertebral height ratio.Surgical duration,cement volume,cement distribution and the occurrence of cement leakage were compared between the two groups.Results The average follow-up of the two groups was(15.3±8.4)months and(18.6±8.2)months,and there was no significant difference between the two groups(P>0.05).The VAS score and ODI were significantly improved after operation in both groups(P<0.05).There was no significant difference between the final follow-up and postoperation in both groups(P>0.05).The VAS score and ODI at postoperation and the final follow-up were significantly different between the two groups(P<0.05),while no statistical significance at the rest of the time(P>0.05).As for the anterior relative vertebral height ratio and the local kyphosis angle,there was no significant difference at preoperation,postoperation and final follow-up(P>0.05).The cement injectable working time in low-temperature intermittent cement injection technique group was significantly longer than that in temperature gradient cement injection technique group(P<0.05),but there was no significant difference in surgical duration(P>0.05).The cement volume and cement distribution in low-temperature intermittent cement injection technique group was superior to temperature gradient cement injection technique group.Cement leakage occurred in only 2 patients,with a leakage rate of 6.7%,in low-temperature intermittent cement injection technique group,which was significantly lower than that of 26.7%in temperature gradient cement injection technique group(P<0.05).Conclusion The application of low-temperature intermittent cement injection technique in the treatment of osteoporotic vertebral compressionfracture with peripheral wall damage by PKP can effectively prolong cement injectable working time,which is beneficial to increase cement volume and distribution in the vertebral body,and obtain better clinical results.Also,it can reduce the incidence of cement leakage.