G型臂X线机在椎体后凸成形术治疗骨质疏松性椎体压缩骨折中的应用分析

The Role of G-arm X-ray Machine in the Treatment of Osteoporotic Vertebral Compression Fractures with Percutaneous Kyphoplasty

目的分析G型臂X线机在椎体后凸成形术(percutaneous kyphoplasty, PKP)治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture, OVCF)中的应用效果。方法选取延安大学附属医院骨科2016年3月—2017年9月采用PKP治疗OVCF患者154例(182椎体),根据术中引导、监测方法的不同分为G臂组75例(90椎体)和C臂组79例(92椎体),G臂组采用G型臂X线机辅助PKP治疗OVCF,C臂组采用C型臂X线机辅助PKP治疗OVCF。比较两组患者手术时间、术中X线透视次数、骨水泥漏发生情况,术前、术后及末次随访时伤椎前缘高度、伤椎后凸Cobb角、疼痛视觉模拟评分(visual analogue scale, VAS)、Oswestry功能障碍指数(Oswestry dability index, ODI)评分。结果两组手术均顺利完成,术中均未发生神经、血管损伤等并发症。G臂组手术时间短于C臂组,术中X线透视次数少于C臂组,差异均有统计学意义(P<0.01);两组骨水泥漏发生率比较差异无统计学意义(P>0.05)。两组术后及末次随访时伤椎前缘高度、伤椎后凸Cobb角、VAS评分、ODI评分均较术前显著改善,差异均有统计学意义(P<0.01);但两组术后、末次随访时上述指标比较差异均无统计学意义(P>0.05)。结论 G型臂X线机辅助PKP治疗OVCF安全可行,与常规C型臂X线机辅助治疗相比,还可有效地缩短手术时间、减少术中X线透视次数。

Objective To analyze the effect of G-arm X-ray machine in the treatment of osteoporotic vertebral compression fracture (OVCF) with percutaneous kyphoplasty (PKP). Methods We enrolled 154 patients (182 vertebrae) with OVCF treated with PKP in the Department of Orthopedics, the Affiliated Hospital of Yan'an University from March 2016 to September 2017. The patients were divided into G-arm group ( n =75, 90 vertebrae) and C-arm group ( n =79, 92 vertebrae) by different intraoperative guidance and monitoring methods. In the treatment of OVCF, the G-arm group was treated with G-arm X-ray machine assisted PKP, while the C-arm group was treated with C-arm X-ray machine assisted PKP. The duration of operation, intraoperative times of exposure to fluoroscopy, and number of cement leakages as well as the anterior height of the injured vertebrae, the kyphotic Cobb angle, visual analogue scale (VAS) score, and Oswestry dysfunction index (ODI) score preoperatively, postoperatively and at final follow-up were compared between the two groups. Results The surgeries of both groups were successfully completed and no complications such as nerve and vascular damage occurred during the operation. The duration of operation and intraoperative times of exposure to fluoroscopy in the G-arm group were significantly shorter or fewer than those in the C-arm group, respectively ( P <0.01). There was no significant difference between the two groups in the number of cement leakages ( P >0.05). The anterior height of the injured vertebrae, the kyphotic Cobb angle, VAS score, and ODI score after surgery and at final follow-up of both groups were significantly improved compared with those before surgery ( P <0.01);while there was no significant difference in the above indicators after surgery and at final follow-up between the two groups ( P >0.05). Conclusion Compared with the conventional C-arm X-ray machine, the G-arm X-ray machine was safe and feasible in the treatment of OVCF with PKP. In addition, it could effectively shorten the duration of operation, and reduce the intraoperative times of exposure to fluoroscopy .