改良经皮椎体成形术在老年骨质疏松性椎体压缩骨折中的临床应用

Clinical application of advanced percutaneous vertebroplasty in treating of senile osteoporotic vertebral compression fracture

目的:比较改良经皮椎弓根穿刺(用穿刺针在椎板、横突上滑移探查,识别椎弓根的进针位置)与常规椎弓根穿刺区别,评价改良经皮椎弓根穿刺在老年骨质疏松性椎体压缩骨折中的临床应用价值。方法:自2010年1月至2011年1月,采用信封法隐藏随机分组方案,按照是否采用改良经皮椎弓根穿刺,将接受经皮椎体成形术(PVP)治疗的老年椎体压缩性骨折患者28例分为常规穿刺组和改良穿刺组,其中男5例,女23例;年龄53～85岁,平均(70.50±9.33)岁;病程2～28d,平均(7.62±4.52)d。骨折部位累及34椎(胸椎19节,腰椎15节),术后应用抗生素3d预防感染。比较两组手术时间、X线透视次数,采用视觉模拟疼痛(visual analogue scales,VAS)评分对疼痛缓解情况进行评价。结果:手术时间常规穿刺组(49.00±7.74)min,与改良穿刺组(32.36±4.81)min比较差异有统计学意义(t=6.828,P=0.000<0.05);术中透视次数常规穿刺组(8.78±2.33)次,改良穿刺组(4.28±1.38)次,两组比较差异有统计学意义(t=6.222,P=0.000<0.05);术后VAS评分常规穿刺组(2.85±0.94)分,改良穿刺组(2.57±1.08)分,两组比较差异无统计学意义(t=0.740,P=0.456>0.05)。结论:改良经皮椎弓根穿刺与常规穿刺相比缩短了手术时间,减少了术中透视次数,进一步降低了影像监测费用和手术风险,更有利于骨水泥椎体成形术在老年骨质疏松性骨折的应用。同时也为椎体活检、椎弓根钉的微创固定提供了参考。

Objective：To compare the differences between advanced percutaneous vertebroplasty and routine percutaneous vertebroplasty,and evaluate the clinical application of advanced percutaneous vertebroplasty in treating senile osteoporotic vertebral compression fracture. Methods：From January 2010 to January 2011,28 patients with senile osteoporotic vertebral compression fracture were concealed random allocated to advanced percutaneous vertebroplasty and routine percutaneous vertebroplasty group according to whether using advanced percutaneous pedicle puncture. Of them ,there were 5 males and 23 females with an average age of （70.50±9.33） years old （ranged,53 to 85）. Course of disease was from 2 to 28 days with an average of （7.62±4.52）. The fracture involved 34 vertebral bodies （19 segments of thoracic vertebrae and 15 segments of lumbar vertebra）,3 day’s antibiotics were applied to prevent infections. The opreation time ,X-ray fluoroscopy times were compared,and pain relief effect were evaluated by VAS （visual analogue scales） score. Results：For operation time,there were significant meaning between routine group （49.00±7.74） min and advanced group （32.36±4.81） min （t=6.828,P=0.000 0.05）; X-ray fluoroscopy times in advanced group （4.28±1.38） times was shorter than routine group （8.78±2.33）times,and had statistical significance（t=6.222,P=0.0000.05）; while there were no meaning in VAS scores between routine group（2.85± 0.94）and advanced group （2.57±1.08）（t=0.740,P=0.4560.05）. Conclusion：Compared with routine group,advanced group can shorten opreration time,reduce radiological hazard,further reduce image monitoring costs and surgical risk,and benefit from the application of advanced percutaneous vertebroplasty in treating senile osteoporotic vertebral compression fracture. Furthmore,it can provide reference to vertebral body biopsy and minimally invasive of pedicle screw fixation.