经单侧椎弓根不同穿刺技术治疗骨质疏松性腰椎压缩骨折临床疗效和骨水泥分布研究

Effects and bone cement distributions of different unilateral transpedicle puncture techniques in the treatment of lumbar osteoporotic vertebral compression fractures

目的探讨经单侧椎弓根行常规穿刺、横突根部穿刺和弯角穿刺椎体成形术(percutaneous curved vertebroplasty,PCVP)治疗腰椎骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCFs)的临床效果和骨水泥分布特点。方法分析自2017年3月至2018年9月,我院行PCVP治疗的88例腰椎单椎体新发OVCFs患者,按照穿刺方式不同分为常规组(常规穿刺)30例、横突组(横突根部穿刺)29例和弯角组(弯角穿刺)29例。记录手术时间、骨水泥量、术中透视次数以及手术并发症发生情况。分别于术前、术后48 h、术后6个月记录患者疼痛视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(oswestry disability index,ODI),评估患者疼痛缓解和腰椎功能改善情况。根据术后X线片分析骨水泥分布及渗漏情况。结果所有患者均顺利完成手术,无血管损伤、神经损伤、骨水泥栓塞等并发症发生。各组手术时间差异无统计学意义。弯角组骨水泥注入量多于常规组和横突组,差异有统计学意义(P<0.05)。三组术后48 h VAS均较术前降低(P<0.05),弯角组和横突组与常规组差异有统计学意义(P<0.05),弯角组与横突组间差异无统计学意义(P>0.05)。术后6个月三组VAS差异无统计学意义(P>0.05),常规组和术前、术后48 h差异有统计学意义(P<0.05)。术后48 h所有患者ODI均较术前降低(P<0.05),弯角组和横突组与常规组差异有统计学意义(P<0.05),弯角组与横突组间差异无统计学意义(P>0.05)。术后6个月三组ODI差异无统计学意义(P>0.05),但常规组和术前、术后48 h差异有统计学意义(P<0.05)。术后正位X线片显示常规组骨水泥主要分布呈偏侧分布、横突组骨水泥主要为近中线分布、弯角组在椎体两侧均匀分布。本组共发生20例渗漏,其中常规组9例(30.0%,9/30),横突组6例(20.1%,6/29),弯角组5例(17.2%,5/29)。结论三种穿刺技术均可获得良好的远期手术效果。但横突根部穿刺和弯角穿刺技术近期临床疗效更优,且弯角穿刺技术可以通过骨水泥推注点的改变获得更均衡的骨水泥分布。

Objective To investigate effects and bone cement distributions of percutaneous curved vertebroplasty(PCVP)with routine puncture,transverse process root puncture and curved puncture in the treatment of lumbar osteoporotic vertebral compression fractures(OVCFs).Methods A total of 88 patients with OVCFs of a single lumbar vertebrate,admitted from March 2017 to September 2018,underwent PCVP.All were divided into routine puncture group(n=30),transverse process root puncture group(n=29)and curved puncture group(n=29)according to different puncture methods.Operation time,bone cement volume,intraoperative radiography frequency and complications were recorded.Visual analogue scale(VAS)and Oswestry disability index(ODI)were recorded before operation,48 hours after operation,and 6 months after operation to assess the pain relief and lumbar spine functions.Distribution and leakage of bone cement were analyzed on postoperative X-rays images.Results All operations were successfully completed without complications such as blood vessel injury,nerve injury or bone cement embolism.There were no significant differences in the operation time among 3 groups.The amount of bone cement injected in the curved group was significantly higher than that in the routine group and transverse process group(P<0.05).VAS scores of all the three groups 48 h after operation were lower than those before operation(P<0.05),and the routine group was significantly higher than that of the curved group and transverse process group(P<0.05),while no significant differences were observed between the curved group and transverse process group(P>0.05).There were no significant differences in the VAS scores of the three groups 6 months after surgery(P>0.05),but not for the routine group preoperatively and 48h postoperatively(P<0.05).ODI scores of all patients before operation were significantly higher than that 48 hours after operation(P<0.05),and the routine group was significantly higher than that of the curved group and transverse process group(P<0.05),but no significant differences were observed between the curved group and transverse process group(P>0.05).There were no significant differences in the ODI scores of all the three groups 6 months after surgery(P>0.05),but not for the routine group preoperatively and 48h postoperatively(P<0.05).Postoperative X-ray images showed bone cement lateralization in the routine group,centerline distribution in the transverse process group and balanced distribution in the curved group.Twenty cases of leakage occurred among all the patients,including 9 cases in the routine group(30.0%,9/30),6 cases in the transverse process group(20.1%,6/29),and 5 cases in the curved group(17.2%,5/29).Conclusions All three puncture techniques can obtain good long-term surgical results.However,transverse process root puncture and curved puncture achieve better short-term therapeutic effects,while curved puncture can obtain a more balanced distribution by the change of bone cement injection point.