侧卧位椎弓根外侧穿刺法椎体成形术治疗骨质疏松性胸腰椎压缩骨折临床分析

Clinical Analysis of Lateral Pedicle Puncture Vertebroplasty in Lateral Lying Position for Treatment of Osteoporotic Thoracolumbar Vertebral Compression Fracture

目的对侧卧位椎弓根外侧穿刺法椎体成形术治疗骨质疏松性胸腰椎压缩骨折进行临床分析。方法选择120例骨质疏松性胸腰椎压缩骨折患者,随机分为两组(各60例);对照组手术采用俯卧位椎弓根入路,观察组手术采用侧卧位椎弓根外侧入路;记录手术舒适度和配合度情况、疼痛VAS评分、ODI评分百分比、手术时间、C臂透视次数、伤椎前缘丢失百分数、骨水泥弥散、骨水泥渗漏等情况,并运用SPSS24.0系统分析。结果观察组出现心率改变2例、血压改变5例、胸闷1例,对照组出现心率改变12例、血压改变18例、心慌3例、胸闷11例、恶心5例;观察组主动配合56例、被动配合4例、无不配合病例,对照组主动配合35例、被动配合23例、不配合2例;VAS评分观察组术前(3.55±1.61)、术后第三天(0.78±0.45),对照组术前(3.23±1.61)、术后第三天(1.12±0.96);ODI评分百分比观察组术前(97.30±2.13)、术后(16.10±8.70),对照组术前(97.12±2.18)、术后(16.63±8.43);手术时间观察组为(38.14±9.75)min,对照组为(50.60±14.15)min;术中透视次数观察组为(18.75±2.78)次,对照组为(27.45±4.34)次;伤椎前缘高度恢复百分比观察组为(55.00±20.53),对照组为(48.50±16.02);观察组骨水泥分布理想60例、渗漏2例,对照组骨水泥分布理想48例、渗漏9例;两组比较,手术舒适度和配合度情况、术后疼痛VAS评分、术后ODI评分百分比、手术时间、C臂透视次数、伤椎前缘丢失百分数、骨水泥弥散、骨水泥渗漏,差异均有统计学意义(P<0.05)。结论侧卧位椎弓根外侧穿刺法有较高手术舒适度、配合度,能较快缓解疼痛,能明显减少术中透视、达到理想骨水泥分布、减少渗漏,能明显改善患者生活质量,值得临床推广。

Objective The clinical analysis of osteoporotic thoracolumbar vertebral compression fracture was carried out by lateral pedicle puncture vertebroplasty in lateral lying position.Methods 120 patients with osteoporotic thoracolumbar vertebral compression fracture were randomly divided into two groups(60 cases in each group),the control group was treated with prone position pedicle approach,and the observation group was treated with lateral pedicle approach in lateral position.The degree of comfort and compatibility,the pain VAS score,the percentage of ODI score,the operation time,the number of C-arm fluoroscopy,the percentage of the injured front edge loss,the bone cement dispersion and the cement leakage were recorded and analyzed by SPSS24.0 system.Results There were 2 cases of heart rate change,5 cases of blood pressure change,1 case of chest tightness in the observation group,12 cases of heart rate change,18 cases of blood pressure change,3 cases of palpitation,11 cases of chest tightness and 5 cases of nausea in the control group.There were 56 cases of active cooperation and 4 cases of passive cooperation in the observation group.There were 35 cases of active cooperation,23 cases of passive cooperation and 2 cases of non-cooperation in the control group.The VAS score was(3.55±1.61)before operation and(0.78±0.45)on the third day after operation in the observation group.The VAS score was(3.23±1.61)before operation and(1.12±0.96)on the third day after operation in the control group.The percentage of ODI score in the observation group was(97.30±2.13)before operation and(16.10±8.70)after operation.The percentage of ODI score in the control group was(97.12±2.18)before operation and(16.63±8.43)after operation.The operation time was(38.14±9.75)min in the observation group and(50.60±14.15)min in the control group.The frequency of intraoperative fluoroscopy was(18.75±2.78)times in the observation group and(27.45±4.34)times in the control group.The percentage of height recovery of anterior edge of injured vertebrae was(55.00±20.53)in the observation group and(48.50±16.02)in the control group.here were 60 cases of ideal distribution of bone cement and 2 cases of leakage in the observation group,48 cases of ideal distribution of bone cement and 9 cases of leakage in the control group.There were significant differences in surgical comfort and matching degree,postoperative pain VAS score,postoperative ODI score percentage,operation time,C-arm fluoroscopy times,loss of anterior edge of injured vertebrae,diffusion of bone cement and leakage of bone cement between the two groups.Conclusion Lateral pedicle puncture in lateral position has high surgical comfort and fit,can relieve pain quickly,obviously reduce perspective in operation,achieve ideal bone cement distribution,reduce leakage,obviously improve the quality of life of patients,and is worthy of clinical promotion.