单侧椎弓根旁入路在中上胸椎骨质疏松性压缩骨折经皮椎体成形术中的临床研究

Clinical study on percutaneous vertebroplasty via unilateral parapedicular pathway for themiddle upper thoracic osteoporotic vertebral compression fractures

目的探讨单侧椎弓根旁入路经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗中上胸椎骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCFs)的特点、可行性与疗效。方法2017年1月—2018年12月我院收治101例中上胸椎OVCFs患者(共165个椎体),均采用单侧椎弓根旁入路穿刺行PVP。术中记录手术时间、出血量、骨水泥灌注量、骨水泥渗漏情况,比较术前、术后1 d及术后12个月随访时视觉模拟疼痛评分(visual analogue pain scales,VAS)、后凸角(Cobb)。结果101例PVP手术时间16~87 min,术中出血量0~8 ml,单个椎体骨水泥量1.5~4.0 ml。骨水泥在椎体内分布对称,无穿刺并发症。术后均获得12个月随访,VAS评分术前、术后1 d、术后12个月分别为(7.86±1.05)分、(3.52±0.64)分、(2.04±0.53)分,术前与术后1 d、术后12个月时VAS评分比较差异均有统计学意义(P<0.05),疼痛明显改善;术前、术后1 d及术后12个月时Cobb角分别为(9.73±3.27)°、(9.05±3.06)°、(9.10±3.04)°,差异均无统计学意义(P>0.05)。结论单侧椎弓根旁入路行PVP术治疗中上胸椎OVCFs是一种有效、安全、可靠的治疗方法,尤其适用于中上胸椎重度压缩骨折。

Objective To explore the characteristics,feasibility and efficacy of percutaneous vertebroplasty(PVP)via unilateral parapedicular approach for the treating of middle upper thoracic osteoporotic vertebral compression fractures(OVCFs).Methods From January 2017 to December 2018,101 patients(165 vertebrae)with middle-upper thoracic OVCFs all underwent PVP via unilateral parapedicular pathway at our hospital.The operative time,amount of blood loss,volume of perfused bone cement and cement leakage were recorded.The visual analogue pain scales(VAS)and Cobb angle before operation,at the first day and the twelfth month after operation were compared.Results The PVP time for 101 patients was 16 to 87 minutes,blood loss was 0 to 8 ml,and volume of bone cement for one vertebra was 1.5 to 4.0 ml.The bone cement was symmetrically distributed in the vertebrae and no complication of puncture occurred.All cases were followed up for 12 months.The VAS score was(7.86±1.05),(3.52±0.64)and(2.04±0.53)respectively before operation,at the first day and the twelfth month after operation,and there was statistic difference by comparison of preoperative VAS with the VAS at the first day and the twelfth month after operation(P<0.05),and the pain were significantly improved.The Cobb angle was(9.73±3.27)°,(9.05±3.06)°and(9.10±3.05)°respectively before operation,at the first day and the twelfth month after operation,and there was no statistic difference among them(P>0.05).Conclusion The procedure of PVP via unilateral parapedicular pathway is safe,feasible,and effective for treating middle and upper thoracic OVCFs,especially suitable for middle and upper thoracic vertebrae with severe compression fracture.