经皮椎体后凸成形术穿刺失败的回顾性分析

Retrospective Analysis on the Puncture Failure of Percutaneous Kyphoplasty

目的探讨经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)穿刺失败的相关因素及预防措施。方法回顾性分析2011年2月至2017年5月间收治的PKP治疗骨质疏松性椎体压缩性骨折(osteoporotic vertebral compression fracture,OVCF)病例共473例,男182例,女291例;年龄67~95岁,平均76.9岁,共手术577个椎体,术中使用C型臂机透视手术节段正侧位X线片,术后1个月复查手术节段正侧位X线片及CT,记录穿刺失败的解剖位置。分析穿刺失败的发生率及相关危险因素。结果 473例患者一共577个椎体,穿刺失败42例,42个椎体,穿刺失败率7.3%,其中椎弓根型8例,终板型8例,椎体外侧壁型16例,椎体前壁型10例。结论预防穿刺失败出现的关键是熟悉骨质疏松性骨折的影像学变化,规范透视,手术操作标准熟练,术中C型臂机多方位检测,能减少穿刺失败的发生率。

Objective To investigate the relative factors and prevention of puncture failure of percutaneous kyphoplasty.Methods A retrospective analysis of 473 osteoporotic vertebral compression fracture（OVCF）cases（577 vertebrae）who underwent PKP under C-arm X-ray in our hospital from February 2011 to May 2017,including 182 males and 291 females.The positive and lateral radiographs and CT of the operation section were recorded 2 days after operation and after one month,and the anatomic location of the failed puncture was recorded.Results There were 577 vertebral bodies in 473 patients.The puncture failed in 42 vertebral bodies in 42 cases.The rate of puncture failure was7.3%.Among them,there were 8 cases of pedicle type,8 cases of endplate type,16 cases of lateral wall type and 10 cases of anterior wall type.Conclusion The keys to prevent puncture failure are understanding of image changes of OVCF,standardrized image perspective,skilled operation and multi azimuth C arm image.