靶向椎体成形术与传统椎体成形术治疗骨质疏松性椎体压缩骨折的疗效比较

Efficacy comparison between targeted and conventional percutaneous vertebroplasty of osteoporotic vertebral compression fractures

目的比较传统经皮椎体成形术（PVP）与靶向PVP治疗骨质疏松性椎体压缩骨折（OVCFs）的临床效果。方法采用回顾性对照研究分析2014年1月-2015年12月收治的215例单节段OVCFs患者临床资料，根据手术方法分为传统PVP组（126例）和靶向PVP组（89例）。靶向PVP向骨折区域穿刺置管及侧口推杆推注骨水泥。根据骨水泥在骨折区域的填充情况把传统PVP组分为填充充分亚组（110例）和填充不充分亚组（16例）。比较两组手术时间、骨水泥注入量、骨水泥渗漏率及渗漏类型、骨水泥在骨折区域填充情况及胸腰背疼痛视觉模拟评分（VAS）。结果靶向PVP组的手术时间长于传统PVP组（P〈0．05），两组骨水泥注入量及骨水泥渗漏率、渗漏类型比较差异均无统计学意义（P〉0．05）。靶向PVP组骨折区域均得到充足骨水泥填充，传统PVP组有16例（12．7％）出现骨水泥在骨折区域填充不充分（P〈0．05）。靶向PVP组、填充充分亚组和填充不充分亚组的术前VAS比较差异无统计学意义（P〉0．05），三组术后2dVAS均较同组术前显著降低（P〈0．05），靶向PVP组与填充充分亚组的术后2dVAS比较差异无统计学意义（P〉0．05），但填充不充分亚组的术后2dVAS显著高于填充充分亚组和靶向PVP组（P〈0．05）。结论与传统PVP治疗OVCFs相比，靶向PVP更能保证骨水泥在骨折区域充分填充，减少术后疗效不佳的发生，是一种安全、有效的新技术。

Objective To compare the clinical outcomes between conventional percutaneous vertebroplasty （PVP） and targeted PVP in the treatment of osteoporotic vertebral compression fractures （OVCFs）. Methods A retrospective cohort study was designed to review 215 cases of single level OVCFs hospitalized between January 2014 and December 2015. According to the procedure techniques, the patients were assigned to targeted PVP group （89 cases） and conventional PVP group （126 cases） which was further divided into sufficient filled subgroup （110 cases） and insufficient filled subgroup （16 cases） on basis of cement distribution. Key techniques of targeted PVP included accurate needle insertion to fractured area and cement injection using a push rob with a side opening. Operating time, cement injection volume, rate and types of cement leakage, cement distribution in the fractured area and visual analogue score （VAS） of back pain were compared between the two groups. Results Operating time in targeted PVP group was longer than that in conventional PVP group （P 〈 0.05）. There were no significant differences in cement injection volume and rate and types of cement leakage between the two groups （ P 〉 0.05 ）. None in targeted PVP group showed insufficient cement distribution in fractured area, while 16 cases （ 12.7% ） in conventional PVP group （ P 〈 0.05 ）. No significant differences in preoperative VAS of back pain existed among targeted PVP group, sufficient subgroup and insufficient subgroup （P 〉 0.05 ）. VAS of back pain was significantly decreased after PVP in three groups （P 〈 0.05 ）. Difference in postoperative VAS of back pain between targeted PVP group and sufficient filled subgroup was insignificant （P 〉0. 05）. However, postoperative VAS of back pain in insufficient filled subgroup was significantly increased compared with targeted PVP group and sufficient filled subgroup （ P 〈 0.05 ）. Conclusion Targeted PVP provides sufficient cement to fill the fractured area and decreases incidence of unsatisfactory clinical outcome compared with traditional PVP, indicating a secure and effective new technique in the treatment of OVCFs.