侧开与前开式骨水泥注入器椎体成形治疗骨质疏松性椎体压缩性骨折的比较

文题释义：经皮椎体成形：自Galibert等于1987年首次描述以来，经皮椎体成形已被广泛用于骨质疏松性椎体骨折的治疗，可迅速缓解腰背痛，改善患者活动，是治疗骨质疏松性椎体骨折安全有效的一种微创手术。 侧开口骨水泥注入器：在传统前开口注入器的基础上，通过密封前开口并在远端末端侧向开口来修改套管，侧开口的尺寸对应于套管的横截面。与传统的前开口注入器相比，侧开口骨水泥注入器可改善经皮椎体成形术中的骨水泥充盈模式，引导水泥流向内侧，降低渗漏风险，同时增加骨水泥注入量。 背景：有研究显示与传统的前开口注入器相比，侧开口注入器可改善椎体成形治疗中的骨水泥充盈模式，引导水泥流向内侧，降低渗漏风险，同时增加骨水泥注入量。 目的：探讨采用侧开式注入器进行椎体成形骨水泥注射治疗骨质疏松性椎体压缩性骨折及防止术中骨水泥渗漏的临床疗效。 方法：选择2014年1月至2018年12月衡水市哈励逊国际和平医院收治的220例骨质疏松性椎体压缩性骨折患者，其中114例采用侧开式注入器进行双侧椎弓根椎体成形骨水泥注射治疗，106例采用标准前开式注入器进行双侧椎弓根椎体成形骨水泥注射治疗，术后拍摄X射线和CT扫描评估骨水泥渗漏情况。术前和术后3 d及6个月进行目测类比评分与椎体压缩率评估。研究获得衡水市哈励逊国际和平医院伦理委员会批准(20131214841X)。 结果与结论：①220例患者均顺利完成手术，无任何早期并发症，疼痛均有所缓解，生活质量得到明显改善；②侧开式注入器组骨水泥注射量大于前开式注入器组(P < 0.05)；③两组术后3 d、6个月的目测类比评分均明显低于术前(P < 0.05)，但两组组间比较差异无显著性意义(P > 0.05)；④侧开式注入器组130个椎体中21个椎体发生骨水泥渗漏(渗漏率为16.15%)，前开式注入器组120个椎体中36个椎体发生骨水泥渗漏(渗漏率为30%)，侧开式注入器组骨水泥渗漏率低于前开式注入器组(P < 0.05)；⑤两组术后3 d、6个月的椎体压缩率较术前显著降低(P < 0.05)，两组组间椎体压缩率比较差异无显著性意义(P > 0.05)；⑥结果表明，采用侧开式或前开式注入器进行椎体成形骨水泥注射治疗骨质疏松性椎体骨折均可获得令人满意的临床疗效，但侧开式注入器可优化骨水泥注入模式，降低渗漏及渗入椎体周围血管的潜在风险，同时可通过调整骨水泥注入方向达到较为满意的骨水泥弥漫效果。 ORCID: 0000-0001-5328-9440(庞巨涛) 中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

Lateral versus anterior open injectors in the percutaneous vertebroplasty treatment of osteoporotic vertebral compression fractures

BACKGROUND:Studies have shown that lateral open injectors can improve the cement filling pattern in percutaneous vertebroplasty,direct cement flow into the vertebral body,reduce the risk of leakage,and increase the amount of bone cement injected compared with conventional anterior open injectors.OBJECTIVE:To investigate the clinical efficacy of lateral open injectors in the percutaneous vertebroplasty treatment of osteoporotic vertebral compression fractures and its effect on preventing intraoperative cement leakage.METHODS:A total of 220 patients with osteoporotic vertebral compression fractures admitted at Harrison International Peace Hospital from January 2014 to December 2018 were enrolled.Of these,114 patients underwent bilateral pedicle percutaneous vertebroplasty w ith the lateral open injector,and 106 patients underwent bilateral pedicle percutaneous vertebroplasty with standard anterior open injector.X-ray and CT scans were performed to evaluate bone cement leakage.The Visual Analogue Scale score and vertebral compression rate were evaluated at baseline,postoperative 3 days and 6 months.The study was approved by the Ethics Committee of Harrison International Peace Hospital(approval No.20131214841 X).RESULTS AND CONCLUSION:(1)All the 220 patients successfully completed the operation without any early complications,the pain was alleviated,and the quality of life was significantly improved.(2)The amount of bone cement injected in the lateral open injector group was higher than that in the anterior open injector group(P<0.05).(3)The Visual Analogue Scale scores at 3 days and 6 months postoperatively were significantly lower than those at baseline(P<0.05).There was no significant difference in the Visual Analogue Scale score between two groups(P>0.05).(4)Twenty-one vertebral bodies in 130 vertebrae in the lateral open injector group showed cement leakage(leakage rate of 16.15%).Bone cement leakage(leakage rate of 30%)occurred in 36 out of 120 vertebral bodies in the anterior open injector group.So the leakage rate of cement in the lateral open injector group was lower than that in the anterior open injector group(P<0.05).(5)The vertebral compression rate at 3 days and 6 months postoperatively in the two groups was significantly lower than that at baseline(P<0.05).There was no significant difference in vertebral compression rate between two groups(P>0.05).(6)These results imply that the use of the lateral open or anterior open injector for bone cement injection for percutaneous vertebroplasty for treatment of osteoporotic vertebral fractures can achieve satisfactory clinical outcomes.However,a lateral open injector can optimize bone cement injection mode,reduce the potential risk of leakage and infiltration into the blood vessels around the vertebral body,and adjust the direction of bone cement injection to achieve a satisfactory bone cement filling effect.