体外复位结合单通道穿刺PVP治疗骨质疏松性椎体骨坏死疗效观察

Efficacy of extracorporeal reduction combined with single-channel puncture PVP in the treatment of osteoporotic vertebral osteonecrosis

目的探究体外复位结合单通道穿刺经皮椎体成形术(PVP)治疗骨质疏松性椎体骨坏死临床效果。方法回顾性分析2016年1月~2019年1月78例于秦皇岛市工人医院接受手术的骨质疏松性椎骨坏死患者临床资料,根据手术方式分为观察组36例与对照组42例,观察组行体外复位结合单通道穿刺PVP术,对照组行单通道PVP术。记录两组围术期情况,监测术前、术后3 d、3和6个月骨密度,比较两组手术前后伤椎前缘高度、后凸Cobb角、疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)及术后不良事件。结果观察组双侧椎弓根穿刺率、骨水泥渗漏率均显著低于对照组,PVP术时间、术中X射线暴露时间均显著短于对照组,差异有统计学意义(P <0.05)。两组术前、术后3 d、术后3个月、6个月骨密度值比较差异均无统计学意义(P> 0.05);观察组术后3 d、术后3个月、术后6个月伤椎前缘高度显著高于对照组,后凸Cobb角显著低于对照组,差异有统计学意义(P <0.05);两组术后3 d、术后3和6个月VAS评分、ODI指数均显著低于术前,差异有统计学意义(P <0.05)。两组术后不良事件发生率比较差无统计学意义(P> 0.05)。结论骨质疏松性椎体骨坏死患者行体外复位结合单通道穿刺PVP较单纯PVP能促进骨水泥弥散,减少双侧椎弓根穿刺率及骨水泥渗漏率,对患者椎体高度及Cobb角改善效果更好。

Objective To investigate the clinical effects of extracorporeal reduction combined with single-channel punctur percutaneous vertebroplasty(PVP)in the treatment of osteoporotic vertebral osteonecrosis.Methods The clinical data of 78 patients with osteoporotic vertebral osteonecrosis who underwent surgery in the hospital from January 2016 to January 2019 were retrospectively analyzed.According to the different surgical procedures,the patients were divided into observation group(36 cases)and control group(42 cases).Observation group was scheduled to undergo extracorporeal reduction combined with single-channel puncture PVP while control group was scheduled to undergo single-channel PVP.The perioperative conditions,and anterior height of injured vertebrae,kyphosis Cobb angle,pain visual analogue scale(VAS)and Oswestry dysfunction index(ODI)before and after surgery were compared between the two groups,and the postoperative adverse events were recorded.Results The bilateral pedicle puncture rate and cement leakage rate in observation group were significantly lower than those in control group(P<0.05),and the PVP time,intraoperative X-ray exposure time were significantly shorter than those in control group(P<0.05).There was no significant difference in bone mineral density between the two groups before surgery and at 3 months and 6 months after surgery(P>0.05).At 3 d after surgery,at 3 months after surgery and at 6 months after surgery,the anterior height of injured vertebrae in observation group was significantly higher than that in control group,and the kyphosis Cobb angle was significantly lower than that in control group(P<0.05).At 3 d after surgery,at 3 months after surgery and at 6 months after surgery,the VAS score and ODI index in the two groups were significantly lower than those before surgery(P<0.05).There was no significant difference in the incidence rate of postoperative adverse events between the two groups(P>0.05).Conclusion Extracorporeal reduction combined with single-channel puncture PVP in patients with osteoporotic vertebral osteonecrosis can promote bone cement dispersion,and reduce bilateral pedicle puncture rate and cement leakage rate,and it has better improvement on vertebral height and Cobb angle.