双侧分层穿刺与双侧非分层穿刺椎体成形术在治疗OVCF中椎内骨水泥分布及临床疗效分析

目的探讨经皮双侧分层穿刺椎体成形术治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)椎内骨水泥分布特点及临床治疗有效性。方法回顾性分析2015年6月至2019年2月,85例于我院行椎体成形术治疗的OVCF病例的影像学及临床资料,其中男21例,女64例;年龄(72.6±7.3)岁。依据穿刺入路分为双侧分层穿刺组与双侧非分层穿刺组。统计分析两组间术椎内骨水泥分布情况,骨水泥注入量,手术时间,术前、术后1天、术后2天、末次随访时疼痛视觉模拟评分(visual analogue scale,VAS)及Oswestry功能障碍指数(oswestry disability index,ODI)。结果本组85例均获得3~16个月随访。双侧分层穿刺组骨水泥注入量平均(4.4±1.0)ml,骨水泥连接上下终板分别为:两侧33例,一侧6例,无1例。双侧非分层穿刺组骨水泥注入量平均(5.2±1.2)ml,骨水泥连接上下终板分别为:两侧11例,一侧30例,无4例。双侧分层穿刺组骨水泥量低于双侧非分层穿刺组,差异有统计学意义(P<0.05)。双侧分层穿刺组术椎冠状位中线(中线)两侧骨水泥连接上下终板率高于双侧非分层穿刺组,差异有统计学意义(P<0.05)。两组术后1天、术后2天、末次随访时的VAS及ODI均对应小于术前,差异有统计学意义(P<0.05)。两组手术时间,术前、术后1天VAS及ODI差异无统计学意义(P>0.05)。双侧分层穿刺组术后2天、末次随访时VAS及ODI低于双侧非分层穿刺组,差异有统计学意义(P<0.05)。结论与双侧非分层穿刺入路相比,经皮双侧分层穿刺椎体成形术骨水泥于术椎中线两侧连接上下终板率更高,术后2天、末次随访时疼痛缓解及功能恢复更好。经皮双侧分层穿刺椎体成形术是治疗OVCF的有效手段。

Intravertebral bone cement distribution after percutaneous bilateral stratified or non-strstified vertebroplasty and its clinical effects on OVCF

Objective To analyze the distribution of intravertebral bone cement in the treatment of osteoporotic vertebral compression fracture(OVCF)by percutaneous bilateral stratified or non-stratified vertebroplasty,and to discuss the clinical efficacy.Methods Imaging and clinical data of 85 OVCF patients were retrospectively analyzed from June 2015 to February 2019,including 21 males and 64 females aged(72.6±7.3)years.All patients were divided into bilateral stratified vertebroplasty group and bilateral non-stratified vertebroplasty group.Bone cement distribution and injection amount,operation time,VAS score and ODI index(preoperatively,1 day and 2 days postoperatively,at the last follow-up)were analyzed.Results All patients were followed up for 3-16 months.Bilateral stratified vertebroplasty group:the average injection amount of the bone cement was(4.4±1.0)ml;33 patients on both sides and 6 patients on one side achieved upper and lower endplate connection;1 patient had no endplate connection.Bilateral non-stratified vertebroplasty group:the average injection amount of the bone cement was(5.2±1.2)ml;11 patients on both sides and 30 patients on one side achieved upper and lower endplate connection;4 patients had no endplate connection.The amount of bone cement of the bilateral stratified vertebroplasty group was less than that of the bilateral non-stratified vertebroplasty group with statistical significance(P<0.05).Bone cement connection rate along the coronal midline of the bilateral stratified vertebroplasty group was higher than that of the bilateral non-stratified vertebroplasty group with statistical significance(P<0.05).VAS and ODI of the two groups at 1 day,2 days after operation and the last follow-up were all significantly lower than those before operation(P<0.05),but no significant differences were noted between the two groups in operation time,VAS and ODI before and 1 day after surgery(P>0.05).VAS and ODI of the bilateral stratified vertebroplasty group at 2 days after operation and the last follow-up were all significantly lower than that of the bilateral non-stratified vertebroplasty group(P<0.05).Conclusions Higher rate of bone connection along the midline between upper and lower endplates,better pain relief and functional recovery 2 days after surgery and at the last follow-up are proved in the stratified vertebroplasty.It is recommended in the treatment of OVCF.