3D导航辅助经皮椎体成形术结合术后腰背肌训练治疗骨质疏松性椎体压缩骨折

目的探讨3D导航辅助经皮椎体成形术(PVP)结合术后腰背肌训练治疗骨质疏松性椎体压缩骨折(OVCF)的价值。方法对观察组25例OVCF患者行O臂机3D导航辅助PVP治疗,术后配合系统性腰背肌训练;对对照组25例OVCF患者行传统C臂机透视下PVP,术后进行一般肌肉训练。对比分析2组间术中透视时间、辐射剂量、平均手术时间及术前、术后2 h、1个月、3个月和6个月随访疼痛视觉模拟评分(VAS)的差异;计算技术成功率,观察骨水泥泄漏及其他手术并发症情况。结果 2组技术成功率均为100%(25/25)。观察组术中透视时间及手术时间更短辐,射剂量更低(P均0.05)。观察组及对照组骨水泥泄露发生率分别为4.00%(1/25)和8.00%(2/25)。未见神经根损伤、椎管内血肿、肺栓塞等严重并发症。观察组术后3个月及6个月VAS均明显低于对照组(P均0.05),而术前、术后2 h及术后1个月VAS与对照组间差异均无统计学意义(P均0.05)。结论 3D导航辅助PVP治疗配合术后腰背肌训练,可在安全、有效治疗OVCF的同时缩短手术时间、减少辐射暴露,改善PVP术后中、长期疼痛。

3D navigation assisted percutaneous vertebroplasty combined with postoperative lower-back muscles training in treatment of osteoporotic vertebral compression fracture

Objective To observe value of 3D navigation assisted percutaneous vertebroplasty (PVP) combined with postoperative lower-back muscles training in treatment of osteoporotic vertebral compression fracture (OVCF). Methods Twenty-five consecutive patients with OVCF were enrolled in observation group and treated with 3D navigation assisted PVP using O-arm scanner and postoperatively systematic back muscle exercise, while other 25 OVCF patients in control group were treated with traditional C-arm assisted PVP and postoperatively regular back muscle exercise. Intraoperative fluoroscopy time, mean dose of radiation, mean procedure time, visual analogue score (VAS) before and 2 h, 1 month, 3 months, 6 months after operation were compared between the two groups. Technical success rate was calculated, and vertebral leakages and complications were observed. Results Technical success rate of the two groups were both 100% (25/25). The duration of fluoroscopy and operation were shorter, the radiation dose was lower in observation group (all P<0.05). The incidences of bone cement leakage in observation group and control group was 4.00% (1/25) and 8.00% (2/25), respectively. No serious complication such as nerve root injury, intraspinal hematoma nor pulmonary embolism occurred. VAS at 3 and 6 months after operation in observation group were significantly lower than those in control group (both P<0.05).There was no significant difference of VAS before and 2 h, 1 month after operation between the two groups (all P>0.05). Conclusion PVP guided with 3D navigation combined with postoperative lumbar and dorsal muscle training can safely and effectively treat OVCF, shorten the operation time, reduce radiation exposure and improve the medium and long-term pain symptoms after PVP.