改良与传统穿刺定位方法在PKP手术中的对比研究

Comparative Study between A Novel and Conventional Puncture Positioning methods of Percutaneous Kyphoplasty

目的探讨改良穿刺定位方法与传统穿刺定位方法在经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗胸腰椎椎体骨质疏松性压缩性骨折(osteoporotic vertebral compression fracture,OVCF)的差异;方法回顾性分析2016年1月至2017年6月于我院骨科行PKP手术的70例患者,男25例,女45例,年龄60～76岁,平均为(65±3.2)岁;均为单节段胸腰椎椎体新鲜骨质疏松性压缩性骨折;术中均采用双侧椎弓根经皮穿刺;根据术中穿刺定位方式不同,将其分为采用改良穿刺定位方法的PKP手术组35例(改良组),传统穿刺定位方法的PKP手术方法组35例(传统组),比较两组患者的平均手术时间、术中X线曝光次数、术前及术后次日胸腰背部疼痛视觉模拟评分(visual analogue scale,VAS)、椎体平均高度变化情况、局部Cobb角改善情况。结果两组患者均由同一名外科医生顺利完成手术,改良组的手术时间(39.7±5.6)min、术中X线暴露次数(31±3)次,传统组的手术时间(54.7±3.4)min、术中X线暴露次数(54±6)次,两组间比较有统计学差异(P<0.05)。两组术后次日VAS评分均较术前均明显降低(P<0.05),两组间比较差异无统计学意义(P>0.05);术后两组椎体平均高度及局部Cobb角较术前均有显著恢复(P<0.05),组间比较差异无统计学意义(P>0.05)。结论 PKP手术中,改良穿刺定位方法与传统穿刺定位方法相比,具有相同的临床疗效,可明显缩短手术时间,减少术中透视次数,从而能很好地减少射线对术者及患者的辐射损伤,在患者受益的同时也减少了射线对医生的损害,可在临床推广应用。

Objective To investigate the clinical outcomes of a novel rapid puncture positioning method of Percutaneous Kyphoplasty and Conventional method of Percutaneous Kyphoplasty on the treatment of osteoporotic vertebral compression fracture( OVCF). Methods A retrospective analysis from January 2016 to June 2017 in the Department of orthopedics, General Hospital of Shenyang military region underwent PKP surgery in 70 patients,male 25 cases,female 45 cases,age 60- 76 years old,average( 65 ± 3. 2) years;were single segment thoralumbar vertebrae fresh osteoporotic compression fracture;intraoperative use of bilateral percutaneous puncture;according to the the puncture location during operation in different ways,which can be divided into PKP operation method using the new fast puncture positioning method of the group of 35 cases,conventional PKP surgery group 35 cases,compared to the average operation time,two groups of patients in the X-ray exposure times,before and after the operation. The visual analogue scale( visual analogue scale,VAS),the average height of vertebral body,local improvement of Cobb angle. Results Two groups of patients were operated by the same surgeon successfully,the operation time of new fast puncture positioning method of PKP( 39. 7 ± 5. 6) min,intraoperative X-ray exposure times of( 31 ± 3) times,the operation time of the traditional PKP( 54. 7 ± 3. 4) min,intraoperative X-ray exposure times of ( 54 ± 6),times between the two groups have significant difference( P < 0. 05). Two groups of postoperative day VAS score were significantly decreased( P < 0. 05),there was no significant difference between the two groups( P < 0. 05);the average height of two groups significantly restore vertebral body and local Cobb angle in preoperation after operation( P < 0. 05),the difference between groups was not significant( P > 0. 05). Conclusion A noval puncture positioning method of PKP surgery and PKP surgery,clinical curative effect is the same,but the former has the advantages of shorter operation time,less intraoperative fluoroscopy times so as to reduce radiation damage to the patient and the patient's X-ray,is a surgical approach should be promoted.