单侧经皮穿刺椎体成形术治疗老年胸腰椎压缩性骨折的临床研究

Effects of Unilateral Percutaneous Vertebroplasty on Thoracolumbar Vertebral Compression Fracture in Older Patients

目的 探讨单侧经皮穿刺椎体成形术治疗胸腰椎压缩性骨折的穿刺技术、疗效及安全性.方法 选取35例我院收治的老年骨质疏松性胸腰椎压缩性骨折患者,在个体化穿刺策略下行单侧穿刺椎体成形术,观察穿刺成功率、手术时间、辐射暴露次数、术后骨水泥分布状况、骨水泥渗漏情况、术前及术后疼痛视觉模拟评分(VAS)和腰椎功能障碍指数(ODI)评分等指标.结果 穿刺成功率100%,平均手术时间(20.0±4.5)min,X线机平均透射次数(16.5±3.5)次,骨水泥弥散偏向于穿刺侧,骨水泥单椎体平均注射量(4.50±0.63) ml,患者术后不同时期VAS评分、ODI评分与术前比较,差异有统计学意义(P<0.05),骨水泥渗漏的发生率14.2%.结论 通过术前测量及设计进行单侧穿刺可显著提高穿刺成功率.单侧穿刺椎体成形术在治疗老年骨质疏松性胸腰椎压缩性骨折疗效确切,创伤小,安全可靠,但存在一定缺陷.

Objective To investigate the puncture technique, efficacy and safety of unilateral percutaneous vertebroplasty in the treatment of thoracolumbar vertebral compression fractures in older patients. Methods 35 older patients with osteoporotic thoracolumbar vertebral compression fractures underwent unilateral percutaneous vertebroplasty under individualized puncture strategy. The puncture success rate, procedure time, radiation exposure, postoperative bone cement distribution, bone cement leakage, pain visual analogue score (VAS) and Oswestry disability index (ODI) were evaluated. Results The average procedure time was (20.0±4.5) min. The average number of transmissions of the X-ray machine was ( 16.5±3.5) times. The bone cement dispersed toward the puncture side. The amount of bone cement injection in single vertebral was (4.50±0.63) ml. The scores of VAS and ODI at different time points after operation were lower than before operation ( P<0.05 ). The incidence of bone cement leakage was 14.2%. Conclusion Unilateral percutaneous vertebroplasty is effective in the treatment of osteoporotic thoracolumbar vertebral compression fractures in older patients, with minimal trauma, high safety and reliability. The successful puncture can be achieved by preoperative accurate measurement and design.