PVP术中“补丁技术”对椎体前壁破裂的OVCF治疗效果

目的探索椎体成形术(PVP)中“补丁技术”对于椎体前壁破裂的骨质疏松性压缩性骨折(OVCF)的应用方法和治疗效果。方法选取拟行PVP手术治疗的椎体前壁破裂的OVCF病人72例，随机分为湿沙期骨水泥推注组(A组)、拉丝期骨水泥推注组(B组)、应用“补丁技术”组(面团早期骨水泥封闭椎体前壁破口，然后湿沙期骨水泥推注)(C组)，各24例。术中均双侧穿入，推注速度基本相同，推注的骨水泥量均为4~5 mL。术后拍摄X线片，观察骨水泥的弥散情况和渗漏情况；3组病人术前、术后2 d进行ODI评分，评估疼痛缓解情况。结果A组病人术后病椎骨水泥弥散状况佳，但发生C型渗漏高达13例(渗漏率54.17%)；B组病人术后病椎骨水泥弥散状况欠佳，发生C型渗漏5例(渗漏率20.83%)；C组病人术后病椎骨水泥弥散状况佳，且发生C型渗漏仅1例(渗漏率4.17%)，3组渗漏率间差异有统计学意义(P < 0.01)。3组病人术前ODI评分间差异无统计学意义(P>0.05)；术后2 d，3组病人ODI评分均较术前明显降低(P < 0.01)，且A组和C组均明显低于B组，而A组与C组差异无统计学意义(P>0.05)。结论PVP术中的“补丁技术”不仅有利于骨水泥在病椎内均匀分布，减少再骨折的发生，术后减轻疼痛效果好，且因其极低的渗漏率，手术安全性高。

Effect of "patch technique" in PVP treatment on OVCF with anterior vertebral wall rupture

ObjectiveTo explore the application and therapeutic effect of "patch technique" in percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fracture (OVCF) with rupture of the anterior vertebral body.MethodsA total of 72 OVCF patients with rupture of the anterior vertebral body who underwent PVP were selected.All patients were randomly divided into three groups, 24 cases in each group.Group A: bone cement injection during wet-sand phase, group B: bone cement injection during wire-drawing phase, group C: the "patch technique" was used to seal the fracture of the anterior vertebral body with bone cement in the early dough stage of paste, and then bone cement was injected in wet-sand phase.Both sides were penetrated during the operation, with basically same injection speed and 4-5 mL of bone cement volume for each side.Postoperative X-ray films were taken to observe the diffusion and leakage of bone cement.The pain relief of patients in the three groups was evaluated using the Oswestry disability index (ODI) before and 2 days post operation.ResultsIn group A, the cement in diseased vertebral body was relatively evenly distributed, while type-C leakage occurred in 13 cases (54.17%).In group B, the cement distribution in postoperative diseased vertebral body was relatively scattered, with 5 cases having type-C leakage(20.83%).In the group C, the cement in diseased vertebral body was relatively evenly distributed, there was only 1 case of type-C leakage(4.17%).There was significant difference in leakage rate among the three groups (P < 0.01).There was no significant difference in preoperative ODI scores among the three groups(P>0.05).On the second day after operation, the ODI scores of the three groups were significantly lower than those before operation (P < 0.01), and the ODI scores of group A and group C were significantly lower than those of group B, but there was no significant difference between group A and group C(P>0.05).ConclusionsThe "patch technique" in PVP is beneficial for the even distribution of bone cement in the diseased vertebral body, reducing the occurrence of re-fracture, and alleviating postoperative pain.In addition, due to the lower leakage rate, this technique shows higher safety.