经横突-椎弓根单侧穿刺骨水泥注射椎体成形治疗胸腰椎骨质疏松性椎体压缩骨折

Percutaneous vertebroplasty by bone cement perfusion using the unilateral transverse process-pedicle approach for treatment of thoracolumbar osteoporotic vertebral compression fracture

背景:在应用骨水泥注射椎体成形治疗骨质疏松性椎体压缩骨折过程中,传统的椎弓根穿刺路径极容易刺破椎弓根内侧壁,引发脊髓损伤。目的:探讨经横突-椎弓根单侧穿刺骨水泥注射椎体成形治疗骨质疏松性椎体压缩骨折的临床疗效。方法:纳入2016年11月至2017年3月郑州大学第五附属医院收治的30例(42椎体)骨质疏松性椎体压缩骨折患者,其中男9例,女21例,年龄58-82岁,均进行经横突-椎弓根单侧穿刺骨水泥注射椎体成形治疗,记录骨水泥渗漏情况。治疗前、治疗后1周及末次随访时,影像学观察伤椎椎体高度恢复与Cobb角改变,目测类比评分评估疼痛情况,Oswestry功能障碍指数评估日常活动功能改善情况。试验通过郑州大学第五附属伦理委员会批准。结果与结论:30例患者均顺利完成手术,获得6-9个月的随访;42椎体中,4椎体骨水泥渗漏至椎间隙,2椎体骨水泥渗漏至椎体前缘,无椎管内渗漏,总渗漏率为14%,均未出现不良临床症状;30例患者治疗后1周及末次随访的目测类比评分、Oswestry功能障碍指数评分均明显低于治疗前(P<0.05);30例患者治疗后1周及末次随访的伤椎椎体高度明显高于治疗前(P<0.05),Cobb角明显小于治疗前(P<0.05);结果表明,经横突-椎弓根单侧入路经皮穿刺骨水泥注射椎体成形治疗骨质疏松性椎体压缩骨折是一种安全有效的方法。

BACKGROUND:During vertebroplasty for treatment of osteoporotic vertebral compression fracture,traditional pedicle puncture route easily punctures the medial wall of the pedicle and causes spinal cord injury.OBJECTIVE:To investigate the clinical effect of percutaneous vertebroplasty by bone cement perfusion via using the unilateral transverse process-pedicle approach in the treatment of thoracolumbar osteoporotic vertebral compression fracture.METHODS:Thirty patients(42 vertebral bodies)with osteoporotic vertebral compression fracture who received treatment during November 2016 to March 2017 in the Fifth Affiliated Hospital of Zhengzhou University,China were included in this study.These patients consisted of 9 males and 21 females,aged 58-82 years.All of them underwent percutaneous vertebroplasty by bone cement perfusion via unilateral transverse process-pedicle approach.Bone cement leakage was recorded.Before treatment,1 week after treatment and at the last follow-up,imaging was used to observe the recovery of vertebral height and changes of Cobb angle,to measure Visual Analogue Score,which was used to evaluate the pain,and Oswestry Disability Index score,which was used to evaluate the improvement of daily activity function.This study was approved by the Ethics Committee of The Fifth Affiliated Hospital of Zhengzhou University.RESULTS AND CONCLUSION:All 30 patients successfully completed the operation and were followed up for 6-9 months.Among the 42 vertebral bodies,bone cement leaked to the intervertebral space in 4 vertebral bodies and it leaked to the anterior edge of the vertebral body in 2 vertebral bodies.There was no leakage in the spinal canal,and the total leakage rate was 14%.No adverse clinical symptoms were observed.In 30 patients,Visual Analogue Scores and Oswestry Disability Index scores at 1 week after treatment and at the last follow-up were significantly lower than those before treatment(P<0.05).In 30 patients,at 1 week after treatment and the last follow-up,the vertebral body height of the patients was significantly higher(P<0.05),as well as the Cobb angle was significantly lower(P<0.05),compared with before treatment(P<0.05).The results suggest that percutaneous vertebroplasty by bone cement perfusion via unilateral transverse process-pedicle approach is a safe and effective method for the treatment of thoracolumbar osteoporotic vertebral compression fracture.