经皮椎体后凸成形术中使用明胶海绵减少骨水泥渗漏的可行性及临床疗效

Feasibility and clinical effect of gelatin sponge in reducing bone cement leakage in percutaneous kyphoplasty

目的探讨经皮椎体后凸成形术(PKP)中使用明胶海绵填塞减少骨水泥渗漏的可行性及临床疗效。方法采用回顾性病例对照研究分析2015年1月—2018年12月四川省骨科医院收治的171例(171椎)采用PKP治疗单节段胸腰椎骨质疏松性压缩骨折患者临床资料。其中男66例,女105例;年龄60~87岁[(67.9±6.7)岁]。骨折节段:T1022例,T1128例,T1237例,L134例,L232例,L318例。80例在注射骨水泥前应用明胶海绵的碎屑预先填塞(A组),91例注射骨水泥前不使用明胶海绵碎屑填塞(B组)。比较两组手术时间、骨水泥注射量、骨水泥渗漏发生率、术前及术后1 d,3,6和12个月伤椎前缘高度、Cobb角、视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)的变化。结果患者均获随访1~12个月[(12.8±0.6)个月]。A组手术时间为(48.3±1.2)min,B组为(42.3±1.3)min(P<0.05)。A组骨水泥注射量为(5.4±0.8)ml,B组为(5.6±0.7)ml(P>0.05)。A组骨水泥渗漏发生率为11%(9/80),B组为26%(24/91)(P<0.05)。两组伤椎前缘高度、Cobb角、VAS、ODI在术前及术后各时相点比较,差异均无统计学意义(P>0.05)。结论明胶海绵填塞可减少胸腰椎骨质疏松性压缩骨折PKP术中骨水泥的渗漏率,在矫正后凸、缓解疼痛、改善生活质量方面可取得与PKP相似的疗效。

Objective To explore the feasibility and clinical efficacy of gelatin sponge packing in reducing bone cement leakage in percutaneous kyphoplasty(PKP).Methods A retrospective case-control study was conducted in data of 171 patients(171 vertebrae)with monosegmental lumbar osteoporosis compressive fracture treated by PKP from January 2015 to December 2018 in Sichuan Orthopedic Hospital.There were 66 males and 105 females,with the age of(67.9±6.7)years(range,60-87 years).There were 22 patients with T10 fracture,28 with T11 fracture,37 with T12 fracture,34 with L1 fracture,32 with L2 fracture and 18 with L3 fracture.A total of 80 patients were prefilled with gelatin sponge before injection(Group A),and 91 patients were not filled with gelatin sponge before injection(Group B).The operation time,amount of bone cement,and rate of bone cement leakage were recorded.The change of anterior vertebral height,Cobb angle,visual simulation score(VAS)and Oswestry disability index(ODI)were compared before operation and at postoperative 1 day,3 months,6 months,12 months.Results All patients were followed up for 1-12 months[(12.8±0.6)months].The operation time in Group A and B was(48.3±1.2)minutes and(42.3±1.3)minutes(P<0.05).The amount of bone cement in Group A and B was(5.4±0.8)ml and(5.6±0.7)ml(P>0.05).The incidence of bone cement leakage in Group A and B was 11%(9/80)and 26%(24/91)(P<0.05).There was no significant difference between the two groups in the anterior height of injured vertebrae,change of Cobb angle,VAS and ODI before and after operation(P>0.05).Conclusion Gelatin sponge can reduce the rate of bone cement leakage in PKP for the treatment of thoracolumbar osteoporosis compressive fracture,and has similar effect with PKP in correcting kyphosis,alleviating pain and improving life quality.