靶点穿刺PKP手术治疗骨质疏松性椎体压缩性骨折疗效分析

目的 探讨靶点穿刺经皮后凸成形术（PKP）治疗骨质疏松性椎体压缩性骨折的手术疗效。方法 以2017 年1月—2018年12月采用靶点穿刺PKP治疗骨质疏松性椎体压缩性骨折的118例患者为靶点穿刺组。术前确定穿 刺靶点。CT检查可明确骨折线时，骨折线即为穿刺靶点；CT检查未见明显骨折线时，以MRI抑脂像显示伤椎信号最 高处为穿刺靶点。经椎弓根穿刺到达靶点位置，置入工作套管，疏通骨性通道，置入球囊，扩张后注入骨水泥。与 2015年1月—2016年12月107例采用常规PKP治疗骨质疏松性椎体压缩性骨折患者（常规手术组）进行对比，比较 手术时间、术中出血量、骨水泥注入量、骨水泥渗漏率、邻椎骨折率，以及术前、术后疼痛视觉模拟评分（VAS），伤椎术 前、术后高度。结果 靶点穿刺组骨水泥注入量少于常规手术组（P＜0.01），但在手术时间、术中出血量、骨水泥渗漏 率及术后邻椎骨折发生率方面与常规手术组相比差异无统计学意义（P＞0.05）。2组间术前、术后VAS评分和椎体 高度差异无统计学意义（P＞0.05）；2组术后VAS评分均较术前明显降低，术后椎体高度均较术前增加（P＜0.01）。结 论 靶点穿刺PKP治疗骨质疏松性椎体压缩性骨折可在保证手术疗效的前提下减少骨水泥注入量，是对原有PKP 的改进和完善。

Therapeutic effect of percutaneous kyphoplasty companied with target puncture in the treatment of osteoporotic vertebral compression fractures

Objective To retrospectively review the operative therapy of osteoporotic vertebral compression fractures with target puncture percutaneous kyphoplasty (PKP). Methods From January 2017 to December 2018, 118 cases of osteoporotic vertebral compression fractures treated with target puncture PKP were used as the target puncture PKP group, and 107 cases treated with traditional PKP were used as the traditional PKP group. The target of puncture was the fracture line if the fracture line was clear in CT images. Otherwise, the position with the highest signal in the MRI liposuction sequence was identified as the target of puncture. Target puncture was carried out via pedicle approach. Polymethylmethacrylate bone cement was injected after saccule dilatation. Data of operative time, intraoperative blood loss, quantity of polymethylmethacrylate bone cement, the leakage rate of polymethylmethacrylate bone cement, the rate of adjacent vertebral compression fracture, preoperative and postoperative Visual Analogue Scale (VAS) scores, preoperative and postoperative vertebral height were compared between the two groups. Results The quantity of polymethylmethacrylate bone cement used in the target puncture PKP group was less than that in the traditional PKP group (P＜0.01), but there were no significant differences in operation time, intraoperative blood loss, bone cement leakage rate and the incidence of adjacent vertebral fracture between the two groups (P＞0.05). There were no significant differences in VAS scores and vertebral height before and after operation between the two groups (P＞0.05). The VAS scores of the two groups were significantly lower after operation than those before operation. The vertebral height of both groups increased after operation than that before operation (P＜0.01). Conclusion Compared with the traditional PKP, the target puncture PKP in the treatment of osteoporotic vertebral compression fractures can reduce the quantity of polymethylmethacrylate bone cement on the basis of obtaining the same surgical effect. It is an improvement and perfection of the traditional PKP.