分次球囊扩张技术在治疗骨质疏松性椎体骨折骨水泥渗漏中的应用

Clinical application of kyphoplasty with graded enlargement balloon for osteoporotic vertebral compressive fracture

目的观察分次球囊扩张技术治疗骨质疏松性椎体骨折骨水泥渗漏的临床疗效。方法将骨质疏松性椎体压缩骨折患者162例,根据球囊扩张技术的不同分为传统球囊扩张组(75例)和分次球囊扩张组(87例),比较两组患者手术前、后的疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)评分及伤椎椎体高度恢复率、后凸Cobb′s角、骨水泥渗漏率等。结果两组患者术后的VAS评分、ODI评分均较术前明显改善(P<0.05),两组间VAS评分、ODI指数评分比较差异无统计学意义(P>0.05);两组患者术后在椎体前缘高度及后凸Cobb′s角分别较术前明显改善,差异有统计学意义(P<0.05),两组组间术前、术后椎体前缘高度、Cobb′s角差异均无统计学意义(P>0.05),两组组间术后椎体高度恢复率差异无统计学意义(P>0.05)。分次球囊扩张组骨水泥渗漏率显著低于传统球囊扩张组(10.3%vs. 22.8%),两组比较差异有统计学意义(P<0.05)。结论分次球囊扩张技术与传统球囊扩张技术相比,两者在临床疗效方面相似,均能达到良好的镇痛效果和脊柱功能改善,但在骨水泥渗漏的控制方面,分次球囊扩张技术明显降低了骨水泥渗漏的发生率,且可重复性高,易于操作,提高了经皮穿刺椎体后凸骨水泥成形术的安全性。

Objective To investigate the clinical application of kyphoplasty with graded enlargement balloon for osteoporotic vertebral compressive fractures. Methods A prospective study was conducted in 162 patients with osteoporotic vertebral compressive fracture in our hospital from June 2016 to June 2019. According to different operative methods, they were assigned to traditional percutaneous kyphoplasty group(n=75) and graded enlargement balloon group(n=87). They were compared in terms of visual analogue scale(VAS), Oswestry disability index(ODI), height of the injured vertebra, Kyphosis Cobb′s angle, and volume and leakage of bone cement. Results Significant improvements in VAS and ODI score were noted after operation in both groups, and there were no significant differences between the 2 groups(P>0.05). Significant improvements in Cobb′s angle and height recovery rate were noted after operation in both groups, and there were no significant differences between the 2 groups(P>0.05). The cement leakage rate in graded enlargement balloon group was significantly lower than that in traditional percutaneous kyphoplasty group(10.3% versus 22.8%, P<0.05). Conclusion Compared with traditional percutaneous kyphoplasty, the clinical outcomes of percutaneous kyphoplasty with graded enlargement balloon are similar. Percutaneous kyphoplasty with graded enlargement balloon is effective in preventing cement leakage.