改良推管在单侧椎弓根穿刺经皮椎体后凸成形术的应用

Application of improved injecting tube in percutaneous kyphoplasty through unipedicular puncturing

目的探讨改良推管用于单侧椎弓根穿刺经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)的可行性及疗效。方法2012年1月—2016年1月,将收治并符合选择标准的60例(68个椎体)骨质疏松椎体压缩性骨折(osteoporotic vertebral compression fractures,OVCF)患者随机分为两组:常规组30例(34个椎体)及改良组30例(34个椎体),分别采用常规推管及改良推管行单侧椎弓根穿刺PKP。两组患者性别、年龄、病程、骨折节段及术前疼痛视觉模拟评分(VAS)、椎间高度等一般资料比较,差异均无统计学意义(P>0.05)。记录并比较两组手术时间、骨水泥注入量,术前及术后2 d、末次随访VAS评分,术前及术后2 d、1年椎体高度,术后2 d骨水泥弥散系数。结果术后两组患者穿刺点均愈合良好,均无严重并发症发生。两组手术时间以及骨水泥注入量比较,差异均无统计学意义(t=0.851,P=0.399;t=1.672,P=0.101)。两组各2例术中发生骨水泥渗漏。常规组骨水泥弥散系数低于改良组(t=13.049,P=0.000)。患者均获随访,随访时间12~36个月,平均19个月。两组术后两时间点VAS评分、椎体高度与术前比较,差异均有统计学意义(P<0.05);组内术后两时间点间比较,差异无统计学意义(P>0.05)。两组间术后两时间点以上指标比较,差异均无统计学意义(P>0.05)。X线片复查示,常规组6例、改良组1例患者随访期间发生其他节段椎体压缩性骨折。结论单侧椎弓根穿刺PKP术中,采用改良推管注射骨水泥可以改善骨水泥在椎体内的弥散,恢复椎体高度,有效加强椎体内稳定,减少再骨折发生,疗效满意。

Objective To research the feasibility and effectiveness of percutaneous kyphoplasty （PKP） by improved injecting tube through unipedicular puncturing. Methods Between January 2012 and Junuary 2016, 60 cases （68 vertebrae） of osteoporotic vertebral compression fractures （OVCF） were treated. PKP was performed through unipedicular puncturing with routine injecting tube in 30 cases （34 vertebrae, routine group）, and with improved injecting tube in 30 cases （34 vertebrae, improved group）. There was no significant difference in age, gender, disease duration, fracture level, preoperative visual analogue scale （VAS）, or vertebral height between 2 groups （P〉0.05）. The operation time, the volume of bone cement injected, preoperative and postoperative VAS, and preoperative and postoperative vertebral height, and postoperative distribution coefficient of bone cement were recorded and compared between 2 groups. Results Good healing of puncture points was achieved in 2 groups after PKP, and no serious complication occurred. There was no significant difference in operation time and the volum of bone cement injected between 2 groups （t=0.851, P=0.399; t=1.672, P=0.101）. Bone cement leakage was observed in 2 cases of 2 groups respectively. The distribution coefficient of bone cement in routine group was significantly less than that in improved group （t=13.049, P=0.000）. All patients were followed up 12-36 months （mean, 19 months）. The postoperative VAS and vertebral height were significantly improved when compared with preoperative ones in 2 groups （P〈0.05）, but there was no significant difference in VAS between at 2 days after operation and at last follow-up, in vertebral height between at 2 days after operation and at 1 year after operation, and between 2 groups after operation （P〉0.05）. X-ray films showed vertebral compression fractures in 6 cases of routine group and in 1 case of improved group during follow-up. Conclusion PKPby improved injecting tube through unipedicular puncturing can improve the distribution of bone cement, restore the height and strength of vertebral body, and reduce the incidence of re-fracture.