不同MRI影像特征的骨质疏松性椎体压缩骨折单侧与双侧穿刺椎体成形术的疗效比较

目的比较单侧与双侧穿刺椎体成形术在具有不同MRI影像特征的骨质疏松性椎体压缩骨折的临床疗效。方法回顾性分析2015年1月—2016年12月因骨质疏松性椎体压缩骨折在陆军军医大学大坪医院野战外科研究所脊柱外科行椎体成形术治疗的患者573例(共743个椎体)。根据脊柱MRI影像特点,将骨折椎体分为三组,椎体内有明显的裂隙影像或真空征象为A组(133个椎体),整个椎体均匀呈现高信号为B组(385个椎体),椎体局部呈现高信号为C组(225个椎体),分别采用单侧或双侧穿刺椎体成形术治疗。在三组内比较两种手术方式术后视觉模拟评分(VAS)、骨水泥注入量、骨水泥弥散以及骨水泥渗漏情况。结果所有患者术后疼痛缓解明显。三组患者术前VAS评分分别为6.1±1.4、6.1±1.3、6.0±1.3,术后VAS评分分别为2.3±1.1、2.2±1.1、2.3±1.2,P=0.4847,三组间差异无统计学意义,单侧穿刺与双侧穿刺患者VAS评分分别为2.2±0.8、2.2±1.0,P0.9999,差异无统计学意义。A、B组单侧与双侧穿刺骨水泥注入量[(5.1±1.4)m L、(5.2±1.3)m L vs.(5.2±1.6)m L、(5.8±1.4)m L]差异无统计学意义,C组单侧穿刺骨水泥注入量(4.6±1.2)m L低于双侧穿刺(5.4±1.4)m L。A组单侧与双侧穿刺骨水泥弥散[(58±17)%vs.(56±12)%]差异无统计学意义,B、C组单侧穿刺弥散较双侧穿刺差[(64±16)%、(49±16)%vs.(71±14)%、(56±14)%]。骨水泥渗漏情况,三组共97个椎体有骨水泥渗漏,渗漏率为13.1%。骨水泥渗漏率的比较,A组双侧穿刺28.6%高于单侧穿刺25.0%,B组单侧穿刺11.7%与双侧穿刺11.2%差异无统计学意义,C组单侧穿刺10.8%高于双侧穿刺7.0%。结论在选择单侧穿刺或双侧穿刺时,应根据患者椎体MRI检查影像特点有根据地进行选择,可以尽量缩短手术时间,降低老年患者手术风险。对于椎体内有明显的裂隙影像或真空征象的椎体,选择单侧穿刺能获得很好的弥散效果;对于椎体内局部呈高信号的椎体,选择双侧穿刺能获得更好的弥散效果以及更低的骨水泥渗漏率。

Selection of puncture methods for osteoporotic vertebral compression fractures with different MRI features: comparison of the effects of unilateral puncture and bilateral puncture vertebroplasty

Objective To compare the clinical efficacy of unilateral puncture and bilateral puncture verte-broplasty in patients with different MRI features of osteoporotic vertebral compression fractures .Methods A total of 573 patients (743 vertebrae) who underwent vertebroplasty were treated with osteoporotic vertebral compression frac -tures during the period from Jan.2015 to Dec.2016.According to the different MRI features of osteoporotic vertebral compression fractures ,the 743 vertebrae were divided into three groups.There were significant fissure images or vacu-um signs in group A (133 vertebrae),the whole vertebral body showed high signal in group B (385 vertebrae),and part of the vertebral body showed high signal in group C (225 vertebrae).And they were treated by unilateral punc-ture or bilateral puncture vertebral surgery,respectively.The visual analogue scale score (VAS),bone cement infu-sion,bone cement dispersion,and bone cement leakage were compared.Results All the patients had postoperative pain relief significantly.There was no significant difference between the preoperative VAS scores (6.1 ±1.4,6.1 ± 1.3,6.0 ±1.3) and the postoperative VAS scores (2.3 ±1.1,2.2 ±1.1,2.3 ±1.2)of the three groups.There was no significant difference between unilateral puncture and bilateral puncture in VAS scores and bone cement infusion vol -ume.The bone cement infusion volume of unilateral puncture in group C was less than that in bilateral puncture ((4.6 ±1.2)mL vs.(5.4 ±1.4) mL).There was no significant difference of bone cement dispersion between unilateral puncture and bilateral puncture in group A.Bone cement dispersion in group B ,group C using unilateral puncture was worse than using bilateral puncture ((64 ±16)%,(49 ±16)% vs.(71 ±14)%,(56 ±14)%).A total of 97 verte-brae had bone cement leakage ,and the leakage rate was 13.1%.Bone cement leakage in group A using bilateral puncture was higher than using unilateral puncture (28.6% vs.25.0%),and in the group C was just the opposite (10.8%vs.7.0%),while having no difference in group B(11.7%vs.11.2%).Conclusion Whether it is unilat-eral puncture or bilateral puncture,vertebroplasty is an effective method for the treatment of osteoporotic vertebral com -pression fractures.Unilateral puncture or bilateral puncture can be chosen to get better bone cement dispersion and less bone cement leakage preoperatively on the base of MRI features.