数字减影血管造影引导下单侧穿刺椎体成形治疗骨质疏松性椎体压缩骨折

Unilateral vertebroplasty and kyphoplasty by digital subtraction angiography for the treatment of osteoporotic vertebral compression fractures

目的:探讨数字减影血管造影(digital subtraction angiography,DSA)引导下单侧椎弓根外途径精准穿刺经皮椎体成形术(percataneous vertebroplasty,PVP)或经皮椎体后凸成形术(percataneous kyphoplasty,PKP)治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCFs)的实施方法与疗效。方法:回顾性分析2015年8月至2018年12月收治的骨质疏松性压缩骨折68例,男20例,女48例,年龄为56~90(73.5±8.0)岁,双节段40例,3节段28例,共168个椎体,均采用DSA引导下经单侧椎弓根外途径精准穿刺行PVP或PKP。椎体分布:T_(1)-T_(6)29椎,T_(6)-T_(12)89椎,L_(1)-L_(5)50椎。术中观察穿刺针针尖达到椎体中线的比率,术后记录骨水泥向椎体外渗漏率,测量骨折椎体前缘和椎体中间高度,术前、术后3 d及末次随访时采用视觉模拟评分(visual analogue scale,VAS)和Oswestry指数(Oswestry Disability Index,ODI)分别对疼痛和腰椎功能进行评定。结果:68例椎体骨折均穿刺成功,术中透视穿刺针尖均达到椎体中线,骨水泥在椎体内弥散良好,左右对称分布。手术时间为35~60(41.6±3.2)min,无穿刺并发症。骨水泥每椎注射量3~5(3.6±0.5)ml。骨水泥渗漏8例,渗漏率11.76%。68例患者随访时间12~27(14.3±3.5)个月。术后3 d及末次随访时的VAS评分、ODI指数明显改善(P<0.05)。术后3 d及末次随访时的椎体前缘高度和椎体中间高度明显恢复(P<0.05)。结论:DSA引导下经单侧椎弓根外途径精准穿刺行PVP或PKP治疗骨质疏松性椎体压缩骨折,能够有效缓解疼痛,恢复椎体高度和脊柱功能,是一种安全、快速、有效的手术方法。

Objective:To explore the methods and efficacy of unilateral extra-pedicle precision puncture percutaneous vertebroplasty(PVP)or percutaneous kyphoplasty(PKP)by digital subtraction angiography(DSA)for the treatment of osteoporotic vertebral compression fractures(OVCFs).Methods:The clinical data of 68 patients with osteoporotic vertebral compression fractures treated from August 2015 to December 2018 were retrospectively analyzed.There were 20 males and 48 females,aged 56 to 90(73.5±8.0)years,40 cases of double segments,28 cases of three segments,a total of 168 vertebrae.All the patients were performed PVP or PKP through unilateral extra-pedicle precision puncture under the guidance of DSA.The vertebrae were distributed in T_(1)-T_(6)(29 vertebrae),T6-T12(89 vertebrae),and L_(1)-L_(5)(50 vertebrae).Whether the puncture needle tip reached the midline of vertebral body was observed during operation,the leakage rate of bone cement was recorded after operation.The height of anterior edge and middle of the fractured vertebral body were measured after operation.Visual analogue scale(VAS)and the Oswestry Disability Index(ODI)were used to assess pain and lumbar function before operation,3 days after operation and final follow-up time.Results:All the punctures were successful in 68 patients.All the puncture needles reached the midline of vertebral body,and the bone cement was well dispersed in the vertebral body with symmetrical distribution.The operation time was 35 to 60(41.6±3.2)minutes,and there was no puncture complications.The injection volume of bone cement was 3 to 5(3.6±0.5)ml in each vertebra.There were 8 cases of bone cement leakage,with a leakage rate of 11.76%.All 68 patients were followed up from 12 to 27(14.3±3.5)months in the study.VAS score and ODI at 3 days after surgery and at final follow-up time were significantly improved(P<0.05).The height of the anterior edge and the middle of vertebral body at 3 days after operation and at final were significantly recovered(P<0.05).Conclusion:PVP or PKP under the guidance of DSA via a unilateral extrapedicular approach with precision puncture can effectively relieve pain,restore vertebral body height and spinal function,which is a safe,fast and effective method in the treatment of osteoporotic vertebral compression fractures.