不同穿刺入路经皮椎体成形术治疗骨质疏松性椎体压缩性骨折的疗效对比

目的对比分析双侧分层交叉穿刺与常规单/双侧穿刺入路行经皮椎体成形术(PVP)治疗骨质疏松性椎体压缩性骨折(OVCF)术后骨水泥分布情况及临床疗效。方法回顾性分析2015年6月—2018年12月采用PVP治疗的127例OVCF患者影像学及临床资料,根据穿刺入路分为双侧分层交叉组(A组,n=37)、常规单侧组(B组,n=48)及常规双侧组(C组,n=42)。记录3组患者手术时间、骨水泥注入量及相关并发症发生情况。术前、术后1 d、术后3 d、末次随访时采用疼痛视觉模拟量表(VAS)评分及Oswestry功能障碍指数(ODI)评估疼痛程度及术后功能恢复情况。术后复查CT三维重建,比较3组椎体内骨水泥分布情况。结果所有手术顺利完成,患者随访3 ～ 15个月。A组于冠状位中线两侧骨水泥连接上下终板率较B、C组显著升高;C组骨水泥注入量较A、B组明显增多;B组手术时间较A、C组明显减少;A组术后3 d、末次随访时VAS评分及ODI较B、C组降低;以上组间差异均有统计学意义(P 0.05)。所有患者均未发生穿刺针道口感染、骨水泥渗漏入椎管、骨水泥拖尾、肺栓塞等并发症。结论与单/双侧穿刺入路PVP相比,双侧分层交叉穿刺PVP术后骨水泥于伤椎冠状位中线两侧连接上下终板率更高,术后疼痛程度、功能状况均改善明显,是治疗OVCF的有效手段,值得临床推广。

Comparison of different puncture approaches for percutaneous vertebroplasty in treatment of osteoporotic vertebral compression fractures

Objective To compare and analyze the distribution of bone cement and clinical effect of percutaneous vertebroplasty(PVP) for osteoporotic vertebral compression fracture(OVCF) between the bilateral laminar cross-puncture and conventional unilateral/bilateral puncture approach. Methods Imaging and clinical data of 127 OVCF patients treated by PVP from June 2015 to December 2018 were retrospectively analyzed. According to different puncture approaches,patients were divided into bilateral laminar cross-puncture group(group A,n=37),conventional unilateral group(group B,n=48) and conventional bilateral group(group C,n=42). The operation time,bone cement injection amount and related complications of the 3 groups were recorded. The visual analogue scale(VAS) score and Oswestry disability index(ODI) were used to evaluate the degree of pain and functional recovery at pre-operation and postoperative 1 d,3 d and the final follow-up. Postoperative CT three-dimensional reconstruction was performed to compare the distribution of bone cement in the vertebral bodies of the 3 groups. Results All the operations were successfully completed,and the patients were followed up for 3-15 months. The rate of upper and lower endplate connection by bone cement on both sides of coronal mid-line was significantly higher in group A than in groups B and C. The injection amount of bone cement in group C was significantly higher than that in groups A and B. The operation time in group B was significantly reduced compared with that in groups A and C. The VAS score and ODI in group A were lower than those in groups B and C at postoperative 3 d and the final follow-up. The differences of above indicators between the 3 groups were statistically significant(P<0.05). All the patients had no complications such as puncture needle orifice infection,bone cement leakage into the spinal canal,bone cement tail-dragging and pulmonary embolism. Conclusion Compared with PVP through unilateral/bilateral puncture,bilateral laminar cross-puncture has a higher rate of upper and lower endplates connection by bone cement on both sides of coronal mid-line,and the postoperative pain degree and functional recovery are significantly improved,is an effective method for the treatment of OVCF,thus being worthy of clinical promotion.