经皮椎弓根穿刺辅助定位导向装置在经皮椎体成形术中的应用

Application of positioning guidance instrument for percutaneous pedicle puncture during percutaneous vertebroplasty

目的评价经皮椎弓根穿刺辅助定位导向装置在经皮椎体成形术(PVP)中的临床应用效果。方法采用前瞻性随机对照设计,将2013年7月至2014年3月收治的52例行单侧PVP的脊柱椎体压缩性骨折患者随机分配到椎弓根穿刺辅助设备穿刺组和徒手穿刺组,对比两组X线透视次数和穿刺时间;采用疼痛视觉模拟量表(VAS)评分评价临床疗效,同时观察手术相关并发症发生情况。结果辅助设备穿刺组、徒手穿刺组术中X线透视次数和穿刺时间分别为(8.5±1.8)次和(15.8±2.1)次、(18±3)min和(31±4)min,两组比较,差异有统计学意义(P<0.05);术后4周VAS评分分别为(2.1±1.4)、(2.3±1.6)分,两组比较,差异无统计学意义(P>0.05)。两组患者均未出现术中神经脊髓损伤症状,术后无伤口出血、感染等并发症,伤口愈合率为100%。结论经皮椎弓根穿刺定位导向装置有助于减少PVP术中X线透视使用次数,缩短手术时间,短期临床疗效与徒手穿刺相似。

Objective To evaluate clinical effects of positioning guidance assisted instrument for percutaneous pedicle puncture during percutaneous vertebroplasty （PVP）. Methods According to randomized prospective controlled design, 52 patients underwent PVP from July 2013 to March 2014 were divided randomly into two groups, instrument-assisted puncture group and free hand puncture group. X-ray fluoroscopy times and time of puncture in two groups were recorded and compared with each other. Visual analogue scale （VAS） scores of pain were evaluated to access the clinical effects, and the complications were also observed. Results X-ray fluoroscopy times and puncture time in instrument-assisted puncture group and free hand puncture group were 8.5 ± 1.8, 15.8 ± 2.1 and （18 ± 3） min, （31 ± 4） min respectively, the difference between two groups had statistical significance （P 〈0.05）; Four weeks after the surgery, VAS scores were （2.1 ± 1.4） and （2.3 ± 1.6） respectively, there were no statistical differences between two groups （P 〉0.05）. Spinal cord injury symptoms were not found during the operation, and no postoperative bleeding or wound infection had happened, wound healing rate was 100%. Conclusion Percutaneous pedicle puncture positioning guidance instrument is helpful for PVP procedure which could reduce X-ray fluoroscopy times, shorten the operation time, and obtain similar short-term effects as free hand puncture.