单侧椎弓根旁入路经皮椎体成形术治疗重度椎体压缩骨折42例

Percutaneous Vertebroplasty for Severe Osteoporotic Vertebral Compression Fractures via Unilateral Papapedicular Approach:Report of 42 Cases

目的探讨单侧椎弓根旁入路经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗重度骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)的疗效。方法2017年1月~2018年12月,对42例重度OVCF采用单侧椎弓根旁入路PVP治疗。所有骨折椎体高度均少于原椎体的1/3。采用单侧椎弓根旁入路穿刺,穿刺成功后注射骨水泥。结果42例均完成手术。手术时间26~45 min,出血量<5 ml,骨水泥注射量1.5~3.5 ml。骨水泥在椎体内分布对称,无穿刺并发症。3个椎体骨水泥渗漏,渗漏率7.1%。均获得随访,随访时间6~12个月。术前、术后1 d及末次随访时疼痛视觉模拟评分(Visual Analogue Scale,VAS)分别为(8.6±0.6)、(3.7±0.5)、(2.1±0.6)分,术后均较术前明显改善(P=0.000)。术前、术后1 d及末次随访时Cobb角分别为9.6°±3.4°、8.9°±3.1°、8.9°±2.6°,术后均较术前明显减小(P=0.000)。结论单侧椎弓根旁入路PVP治疗重度OVCF安全、有效。

Objective To explore the efficacy of percutaneous vertebroplasty(PVP)for severe osteoporotic vertebral compression fractures(OVCF)via unilateral papapedicular approach.Methods A total of 42 cases(42 vertebras)with severe OVCF were admitted from January 2017 to December 2018.PVP was performed via unilateral papapedicular approach.The vertebral body height was less than 1/3 of the original height.Unilateral papapedicular puncture was performed,and cement was injected after puncture.Results The operation was completed successfully in all the 42 cases.The operative duration was 26-45 minutes,the blood loss was less than 5 ml,and volume of bone cement was 1.5-3.5 ml.The bone cement was symmetrically distributed in the vertebrae and no severe complication of puncture was found.Cement leakage occurred in 3 vertebral bodies and the cement leakage rate was 7.1%.All the cases were followed up for 6-12 months.The Visual Analogue Scale(VAS)score was 8.6±0.6,3.7±0.5,and 2.1±0.6 points at preoperation,1 day after operation,and at the last follow-up,respectively,all of which were much improved after operation(P=0.000).The Cobb angle was 9.6°±3.4°,8.9°±3.1°,and 8.9°±2.6°at preoperation,1 day after operation,and at the last follow-up,respectively,all of which were significantly decreased after operation(P=0.000).Conclusion The procedure of PVP via unilateral papapedicular approach is safe and effective for severe OVCF.