自制脊柱定位器加手法复位后行椎体成形术治疗骨质疏松性椎体压缩骨折的临床对照研究

目的: 探讨手法复位联合椎体成形术治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCFs)的临床疗效。方法: 选取2022年1月至2024年3月治疗的61例OVCFs患者,随机分为自制脊柱定位器定位+手法复位组(治疗组)和传统克氏针定位组(对照组)。治疗组30例,男4例,女26例;年龄61~87(73.61±7.17)岁;身体质量指数(body mass index,BMI)为15.24~28.89(23.90±3.20) kg·m^-2;骨密度T值-4.90~-2.50(-3.43±0.75) SD;骨折至手术时间6.50(4.00,10.25) d;骨折压缩情况Genant分级,Ⅰ级10例,Ⅱ级13例,Ⅲ级7例。对照组31例,男7例,女24例;年龄61~89(73.63±8.77)岁;BMI为18.43~27.06(23.67±2.35) kg·m^-2;骨密度T值-4.60~-2.50(-3.30±0.68) SD;骨折至手术时间6.00(3.00,8.00) d;Genant分级,Ⅰ级11例,Ⅱ级9例,Ⅲ级11例。观察并比较两组穿刺次数、X线透视次数、穿刺所需时间,并于术前及术后3 d和1个月观察并比较视觉模拟评分(visual analogue scale,VAS)、腰椎日本骨科协会(Japanese Orthopaedic Association,JOA)评估评分及计时起立-行走测试(timed up and go test,TUGT)。结果: 所有患者获得随访,时间1~3(2.10±0.80)个月。治疗组穿刺次数、X线透视次数、穿刺所需时间分别为5.00(4.00,6.00)次、(29.53±5.89)次、14.83(12.42,21.20) min,对照组分别为7.00(6.00,8.00)次、(34.58±5.33)次、22.19(17.33,27.01) min,治疗组优于对照组(P<0.05)。两组术前VAS、JOA及TUGT比较,差异均无统计学意义(P>0.05);两组术后VAS、JOA及TUGT均较治疗前好转(P<0.05)。术后3 d,治疗组JOA评分23.00(20.75,25.00)分,高于对照组20.00(19.00,23.00)分(P<0.05);术后3 d治疗组TUGT为6.26(5.86,6.57) s,优于对照组6.90(6.80,7.14) s (P<0.05)。术中治疗组出现1例骨水泥渗漏,对照组出现2例骨水泥渗漏。结论: 自制脊柱定位器定位下行椎体成形术联合手法复位的优化方案应用于OVCFs患者,能减少术中穿刺次数,缩短穿刺时间,减少X线透视次数,在恢复术后患者短期腰椎功能、站立行走能力上,相较单纯克氏针定位具有优势。

A controlled clinical study of vertebroplasty for the treatment of osteoporotic vertebral compression fractures after self-made spinal positioner and manual reduction

Objective To explore clinical effect of manipulation reduction combined with vertebral plasty on osteoporotic compression fractures (OVCFs).

Methods Totally 61 patients with OVCFs treated from January 2022 to March 2024 were randomly divided into self-made spinal locator positioning with manipulation reduction group (treatment group) and traditional Kirchner positioning group (control group). There were 30 patients in treatment group,including 4 males and 26 females,aged from 61 to 87 years old with an average of (73.61±7.17) years old;body mass index (BMI) ranged from 15.24 to 28.89 kg·m^-2 with an average of (23.90±3.20) kg·m^-2;bone mineral density T value ranged from -4.90 to -2.50 SD with an avergae of (-3.43±0.75) SD;fracture to operation time was 6.50 (4.00,10.25) d;10 patients were gradeⅠ,13 patients were gradeⅡ,and 7 patients were grade Ⅲ according to Genant classification of fracture compression. There were 31 patients in control group,including 7 males and 24 females,aged from 61 to 89 years old with an average of (73.63±8.77) years old;BMI ranged from 18.43 to 27.06 kg·m-2 with an average of (23.67±2.35) kg·m-2;bone mineral density T value ranged from -4.60 to -2.50 SD with an avergae of (-3.30±0.68) SD;fracture to operation time was 6.00 (3.00,8.00) d;11 patients were gradeⅠ,9 patients were gradeⅡ,and 11 patients were grade Ⅲ according to Genant classification of fracture compression. The puncture times,X-ray fluoroscopy times and puncture time between two groups were observed and compared. Visual analogue scale (VAS),Japanese Orthopaedic Association (JOA) and timed up and go test (TUGT) were observed and compared before operation,3 d and 1 month after operation.

Results All patients were followed up for 1 to 3 months with an average of (2.10±0.80) months. Puncture times,X-ray fluorosecopy times and puncture time in treatment group were 5.00(4.00,6.00) times,(29.53±5.89) times and 14.83(12.42,21.20) min,respectively,while those in control group were 7.00(6.00,8.00) times,(34.58±5.33) times,22.19(17.33,27.01) min,treatment group was better than those of control group (P<0.05). There were no significant differences in preoperative VAS,JOA and TUGT between two groups(P>0.05). VAS,JOA and TUGT in both groups were significantly improved after opeation(P<0.05). On the third day after operation,JOA score of treatment group was 23.00 (20.75,25.00),which was higher than that of control group 20.00(19.00,23.00)(P<0.05). TUGT of treatment group was 6.26(5.86,6.57) s,which was better than that of control group 6.90(6.80,7.14) s (P<0.05). Bone cement leakage occurred with 1 patient in treatment group and 2 patients in control group.

Conclusion The optimal scheme of self-made spinal locators for locating descending verteboplasty combined with traditional Chinese medicine reduction manipulation for OVCF patients could reduce the number of intraoperative puncture times,shorten puncture times and reduce number of X-ray fluoroscopy times,and have advantages over the simple positioning of Kirschn''s needle in restoring short-term lumbar function and standing and walking ability of postoperative patients.