单侧经椎弓根基底部外上穿刺入路在PKP治疗OVCF的疗效观察

目的探讨单侧经椎弓根基底部外上穿刺入路在经皮穿刺球囊扩张椎体后凸成形术(PKP)治疗胸、腰椎骨质疏松性椎体压缩性骨折(OVCF)的疗效。方法收集2016年4月1日至2018年12月31日该院收治的127例胸、腰椎OVCF患者,按穿刺方法分成两组。A组(86例)采用单侧经椎弓根基底部外上穿刺路径,术前在医学影像计算机存档与传输系统(PACS)上分析OVCF椎体及其附近组织结构,同时设计穿刺路径;B组(41例)直接采用双侧经皮椎弓根穿刺路径,术中穿刺成功后进行PKP治疗。比较两组患者手术时间、术中X射线透视次数、骨水泥分布与渗漏及视觉模拟疼痛评分(VAS)变化等情况。结果与B组比较,A组患者平均手术时间更短,平均X射线曝光次数更少,骨水泥渗漏率更低,平均手术出血量更少,骨水泥过中线率更高,差异均有统计学意义(P<0.05);两组患者平均骨水泥填充量及术前和术后24h平均VAS评分比较,差异均无统计学意义(P>0.05)。结论行PKP采用单侧经椎弓根基底部外上穿刺入路治疗OVCF时效果更好。

Observation on efficacy of unilateral transpedicular basal external puncture approach for treating OVCF in PKP

Objective To investigate the efficacy of balloon dilated percutaneous kyphoplasty(PKP)for treating thoracic and lumbar vertebral osteoporosis vertebral compressed fracture(OVCF)by unilateral transpedicular basal external puncture approach.Methods A total of 127 patients with thoracic and lumbar vertebral OVCF in the hospital from April 1,2016 to December 31,2018 were collected and divided into the two groups according to the puncture method.The group A(n=86)adopted unilateral transpedicular basal external puncture approach.The OVCF vertebra and its adjacent tissue structure were analyzed on the medical picture archiving and communication system(PACS)before surgery,and the puncture path was simultaneously designed.The group B(n=41)adopted bilateral transpedicular puncture approach,and PKP was performed after successful puncture during operation.The operation time,number of intraoperative X-ray fluoroscopy,distribution and the leakage of bone cement and change of visual analogue scales(VAS)were compared between the two groups.Results Compared with the group B,the average operative time in the group A was shorter,average X-ray exposure times were fewer,the bone cement leakage rate was lower,the average operative bleeding amount was much less,the rate of bone cement passing the central line was higher,and the differences were statistically significant(P<0.05).But there were no statistically significant differences in the bone cement filling volume and VAS scores before and at postoperative 24 hbetween the two groups(P>0.05).Conclusion Unilateral transpedicular basal external puncture approach in PKP has better effect in the treatment of OVCF.