改良穿刺套管在经皮椎体成形术中预防骨水泥渗漏的研究

Application of a modified puncture cannula to prevent bone cement leakage during percutaneous vertebroplasty

目的探讨改良穿刺套管在经皮椎体成形术(PVP)中预防骨水泥渗漏的效果。方法回顾性分析2014年1月至2018年2月期间上海交通大学医学院附属第九人民医院骨科采用PVP治疗的243例单节段骨质疏松性椎体骨折患者资料。根据穿刺套管不同分为两组:对照组169例,男41例,女128例;年龄为(71.6±9.5)岁;骨折椎体分布:T5~T107个,T11至L2132个,L3~L530个。改良组74例,男20例,女54例;年龄为(73.6±9.3)岁;骨折椎体分布:T5~T103个,T11至L263个,L3~L58个。比较两组患者的术后椎体高度恢复率、VAS评分下降值及骨水泥渗漏情况等。结果两组患者的性别、年龄、骨折椎体分布、椎体压缩程度、后壁完整性、骨水泥注射量等一般资料的比较差异均无统计学意义(P>0.05),具有可比性。对照组患者的术后椎体高度恢复率(7.43%±7.82%)及VAS评分下降值[(5.83±0.99)分]与改良组患者[6.20%±7.84%、(5.81±0.89)分]比较差异均无统计学意义(P>0.05)。对照组有93例(55.0%)患者出现骨水泥渗漏,改良组有26例(35.1%)患者出现骨水泥渗漏,差异有统计学意义(P<0.05)。改良组患者椎旁血管[13.5%(10/74)]、椎旁软组织[9.5%(7/74)]及椎管内骨水泥渗漏发生率[4.1%(3/74)]显著低于对照组患者[25.4%(43/169)、20.1%(34/169)、15.4%(26/169)],差异均有统计学意义(P<0.05)。结论PVP术中应用改良的端侧开口穿刺套管,能够降低骨水泥渗漏率,尤其是椎管内、椎旁血管、椎旁软组织部位骨水泥渗漏率明显降低,同时不影响术后近期疗效,是一种预防骨水泥渗漏的可选方案。

Objective To investigate the effect of a modified puncture cannula on prevention of bone cement leakage in percutaneous vertebroplasty(PVP).Methods From January 2014 to February 2018,243 patients with single-segmental osteoporotic vertebral fracture were treated with PVP at Department of Orthopedics,Shanghai Ninth People's Hospital.Their clinical data were retrospectively analyzed.Of them,a common puncture cannula was used in 169 cases(control group)and a modified puncture cannula in 74(modified group).In the control group,there were 41 men and 128 women with an age of 71.6±9.5 years,and the fracture was distributed from T5 to T10 in 7 cases,from T11 to L2 in 132 and from L3 to L5 in 30.In the modified group,there were 20 men and 54 women with an age of 73.6±9.3 years,and the fracture was distributed from T5 to T10 in 3 cases,from T11 to L2 in 63 and from L3 to L5 in 8.The 2 groups were compared in terms of postoperative recovery of vertebral height,reduction in visual analogue scale(VAS)and bone cement leakage.Results There were no significant differences between the 2 groups in age,gender,distribution of fractured vertebral bodies,compression degree,condition of vertebral posterior wall,or bone cement volume injected(P>0.05).There were no significant differences either between the control and modified groups in the postoperative recovery of vertebral height(7.43%±7.82%versus 6.20%±7.84%)or reduction in VAS score(5.83±0.99 versus 5.81±0.89)(P>0.05).Bone cement leakage occurred in 93 cases(55.0%)in the control group but in 26 cases(35.1%)in the modified group,showing a significant difference(P<0.05).The incidences of bone cement leakage in the paravertebral vessels[13.5%(10/74)],paravertebral soft tissue[9.5%(7/74)]and spinal canal[4.1%(3/74)]in the modified group were all significantly lower than those in the control group[25.4%(43/169),20.1%(34/169)and 15.4%(26/169)](P<0.05).Conclusion Application of the modified end-to-side puncture cannula is an optional scheme to prevent bone cement leakage in PVP,because it can reduce the incidence of bone cement leakage without compromising postoperative short-term outcomes,especially in the spinal canal,paraspinal vessels and paraspinal soft tissue.