对侧补充穿刺在单侧经皮椎体成形术骨水泥弥散不佳中的应用

目的:探讨单侧经皮穿刺椎体成形术(PVP)中骨水泥弥散不佳时,行对侧补充穿刺的临床价值。方法:回顾2015年1月至2016年12月采用单侧穿刺PVP方法治疗285例(319椎)骨质疏松压缩性骨折(OVCF)患者中,骨水泥弥散不佳时行对侧补充穿刺的13例,男5例,女8例;年龄63～88岁;T_(11)1例,T_(12)4例,L_13例,L_22例,L_31例,L_52例;受伤至手术时间1～16 d。观察该组患者VAS评分、ODI评分、残余腰痛、椎体两侧高度丢失等情况。结果:行对侧补充穿刺的13例术后VAS评分、ODI评分均较术前明显改善(P0.01),且均未出现术后残余腰背痛。随访期间内椎体两侧高度丢失(原穿刺侧0.35～3.69 mm;补充穿刺侧0.59～3.66 mm)差异无统计学意义。结论:对于单侧PVP出现骨水泥弥散不佳时,采取对侧补充穿刺能减少术后残余痛的发生,同时可减小椎体两侧高度丢失差值,继而防止患椎侧方畸形的发生,是一种安全可靠的方法及思路。

Application of contralateral supplementary puncture in unilateral percutaneous vertebroplasty for poor bone cement dispersion

Objective: To evaluate the clinical value of contralateral supplementary puncture in unilateral percutaneous vertebroplasty(PVP) with poor cement dispersion.Methods: From January 2015 to December 2016,PVP was performed unilaterally in 285 patients(319 vertebrae) with osteoporotic compression fractures(OVCF). Contralateral percutaneous puncture was performed in 13 patients with poor cement dispersion. Among the patients,5 cases were male and 8 patients were female,ranging in age from 63 to 88 years old;1 case of T₁₁,4 cases of T₁₂,3 cases of L₁,2 cases of L₂,1 case of L₃,and 2 cases of L₅. The time from injury to operation ranged from 1 to 16 days. The VAS score,ODI score,residual low back pain and loss of vertebral height were observed.Results: The VAS score and ODI score of 13 patients who underwent contralateral supplementary puncture were significantly improved (P<0.01),and there was no postoperative residual low back pain. During the follow-up period,there was no significant difference in the height loss between the two sides of the vertebral body (0.35 to 3.69 mm on the original puncture side and 0.59 to 3.66 mm on the supplementary puncture side).Conclusion: For unilateral PVP with poor cement dispersion,contralateral puncture can reduce the occurrence of postoperative residual pain; at the same time,can reduce the difference between the loss of height on both sides of the vertebral body,and then prevent the occurrence of lateral vertebral deformity,which is a safe and reliable method.