双侧孔推注器在经皮穿刺椎体成形术中的临床应用价值

Clinical application of bilateral bolus injection device in percutaneous vertebroplasty

背景:经皮穿刺椎体成形术(PVP)治疗骨质疏松性椎体压缩性骨折具有较好的疗效,但存在骨水泥弥散度不够、骨水泥渗漏等问题。目的:与常规推注器对比,评价双侧孔推注器在PVP中的临床应用价值。方法:回顾性分析2016年3月至2018年3月间接受PVP治疗的106例骨质疏松性椎体压缩性骨折患者。其中42例患者使用双侧孔推注器(双侧孔推注器组),64例患者使用常规推注器(常规推注器组)。记录并比较两组患者手术时间、骨水泥灌注量、骨水泥渗漏率、骨水泥在椎体内的弥散度以及手术前后疼痛视觉模拟评分(VAS)。结果:所有患者均随访1年。双侧孔推注器组患者平均随访(362.5±9.2)d,常规推注器组患者平均随访(352.7±10.4)d。两组患者手术时间、骨水泥灌注量差异无统计学意义。双侧孔推注器组患者骨水泥渗漏率小于常规推注器组患者[14.3%(6/42)vs 31.3%(20/64)],且差异有统计学意义(χ2=3.942,P=0.047)。双侧孔推注器组患者骨水泥过椎体中线率高于常规推注器组患者[95.2%(40/42)vs64.1%(41/64)],且差异有统计学意义(χ2=13.675,P<0.001),说明双侧孔推注器组患者骨水泥在椎体内的弥散度优于常规推注器组患者。两组患者术后1 d、1周及12个月疼痛VAS评分均较术前下降,且差异均有统计学意义(P均<0.001)。但任一时间点两组患者疼痛VAS评分差异均无统计学意义。结论:与常规骨水泥推注器相比,双侧孔推注器治疗骨质疏松性椎体压缩性骨折可达到相近的止痛效果,且使骨水泥弥散更加充分,有效降低了骨水泥渗漏率。

Background: Percutaneous vertebroplasty(PVP) has good curative effect on osteoporotic vertebral compression fracture(OVCF), but there are some problems such as insufficient dispersion of bone cement, leakage of bone cement, etc. Objective: To compare the clinical efficacy of PVP by bilateral bolus injection device and conventional injection device for OVCF. Methods: A retrospective analysis of 106 OVCF patients who underwent surgical treatment from March 2016 to March2018 was performed. The patients were divided into two groups: 42 patients received PVP by bilateral bolus injector(bilateral group), and 64 patients received conventional PVP(control group). The operation time, volume, leakage and dispersion of bone cement, and VAS scores were compared between the two groups. Results: All patients were followed up for one year. The mean duration of follow-up was(362.5±9.2) d in bilateral group and(352.7±10.4) d in control group. There was no statistical difference in operation time or volume of bone cement between the two groups(P>0.05). The incidence of bone cement leakage in bilateral group was significantly lower than that in control group(14.3% [6/42] vs 31.3% [20/64], χ2=3.942, P=0.047). The rate of bone cement over the midline in bilateral group was significantly higher than that in control group(95.2% [40/42] vs 64.1% [41/64],χ2=13.675, P<0.001). Compared with preoperative ones, VAS scores in 1 day, 7 days and 1 year after operation in the two groups were significantly decreased(P<0.001). However, there was no significant difference in VAS scores at any time point between the two groups(P>0.05). Conclusions: Compared with conventional bolus injection device, bilateral hole bolus injection device can achieve the same analgesic effect, more sufficient bone cement dispersion and lower bone cement leakage.