椎体成形与弯角椎体成形治疗骨质疏松性椎体压缩骨折的临床效果与辐射暴露分析

Clinical efficacy and radiation exposure analysis of vertebroplasty and curved vertebroplasty in the treatment of osteoporotic vertebral compression fracture

目的:以经典双侧穿刺椎体成形为参照,评价弯角穿刺装置椎体成形的临床效果,分析术中患者及术者受到的辐射暴露,总结防护措施。方法:对2018年3月至2019年9月收治的49例骨质疏松性椎体压缩骨折的临床资料进行回顾性分析,49例患者按手术穿刺方式的不同分为椎体成形组(采用经典双侧穿刺)与弯角椎体成形组(采用弯角穿刺),其中椎体成形组26例,男7例,女19例;年龄(73.25±6.36)岁;胸段2例,胸腰段21例,腰段3例。弯角椎体成形组23例,男6例,女17例;年龄(73.09±6.52)岁;胸段3例,胸腰段19例,腰段1例。记录两组手术时间、骨水泥注入量,采用视觉模拟评分(visual analogue scale,VAS)和改良Oswestry功能障碍指数(Oswestry Disability Index,ODI)评定患者的疼痛程度及腰椎功能,观察术后骨水泥渗漏及并发症,并比较两组患者、术者部分暴露部位受照辐射剂量。结果:49例患者均获随访,时间10~22(14.55±3.83)个月。椎体成形组11例,弯角椎体成形组9例术后发生骨水泥渗漏,两组比较差异无统计学意义。椎体成形组VAS评分术前及术后1 d分别为6.23±0.68,1.69±0.47,改良Oswestry功能障碍指数分别为(72.59±3.25)%,(33.59±2.85)%。弯角椎体成形组VAS评分术前及术后1 d分别为6.46±0.56,1.57±0.49,改良Oswestry功能障碍指数分别为(73.21±3.18)%,(33.17±2.37)%。两组患者术后疼痛程度和腰椎功能均得到明显改善,但组间比较差异无统计学意义。弯角椎体成形组与椎体成形组手术时间分别为(17.27±9.58)min,(23.19±8.56)min,骨水泥注入量分别为(4.91±1.49)ml,(6.58±1.42)ml,手术时间和骨水泥注入量方面弯角椎体成形组更有优势。弯角椎体成形组受福射剂量术者为(0.53±0.05)mSv,患者为(10.64±1.65)mSv,椎体成形组受福射剂量术者为(0.59±0.08)mSv,患者为(13.52±1.81)mSv。弯角椎体成形组患者的受福射剂量明显低于椎体成形组,而两组术者的受福射剂量差异无统计学意义。结论:两种穿刺方式均能达到满意的临床效果,弯角穿刺可更加优化骨水泥的分布,降低患者的辐射剂量。

Objective:Taking the classic bilateral puncture vertebroplasty as a reference,to evaluate the clinical efficacy of vertebroplasty of the curved-angle puncture device,analyze the radiation exposure of patients and surgeons during the operation and summarize the protective measures.Methods:The clinical data of 49 patients with osteoporotic vertebral compression fractures admitted from March 2018 to September 2019 were retrospectively analyzed.According to the different surgical puncture methods,49 patients were divided into vertebroplasty group(using classic bilateral puncture)and curved vertebroplasty group(using curved-angle puncture).Among them,there were 26 cases in vertebroplasty group,including 7 males and 19 females,aged(73.25±6.36)years,2 cases in thoracic segment,21 cases in thoracolumbar segment,and 3 cases in lumbar segment.In curved vertebroplasty group,there were 23 cases,including 6 males and 17 females,aged(73.09±6.52)years,3 cases in thoracic segment,19 cases in thoracolumbar segment,and 1 case in lumbar segment.The operation time and the amount of injected bone cement in the two groups were recorded.Visual analogue scale(VAS)and modified Oswestry Disability Index(ODI)were respectively used to assess the pain degree and lumbar function,the postoperative bone cement leakage or other complications were observed.The radiation doses of the two groups of patients and surgeons were compared.Results:All 49 patients were followed up for 10-22(14.55±3.83)months.Eleven cases in vertebroplasty group and 9 cases in curved vertebroplasty group occurred bone cement leakage after surgery,and there was no statistically significant difference between two groups.VAS scores of vertebroplasty group were 6.23±0.68 before operation and 1.69±0.47 at 1 day after operation,respectively,modified ODI were(72.59±3.25)%and(33.59±2.85)%.The preoperative and postoperative VAS scores of curved vertebroplasty group were 6.46±0.56 and 1.57±0.49,respectively,modified ODI were(73.21±3.18)%and(33.17±2.37)%.The postoperative pain degree and lumbar function of the two groups were significantly improved,but the difference between the groups was not statistically significant.The operation time of curved vertebroplasty group and vertebroplasty group were(17.27±9.58)min and(23.19±8.56)min,and the amount of injected bone cement were(4.91±1.49)ml and(6.58±1.42)ml.Obviously,curved vertebroplasty group has more advantages in operation time and the amount of injected bone cement.In curved vertebroplasty group,the radiation dose of the operator was(0.53±0.05)mSv and the patient was(10.64±1.65)mSv;in vertebroplasty group,the operator was(0.59±0.08)mSv and the patient was(13.52±1.81)mSv.The radiation dose of patients in curved vertebroplasty group was significantly lower than that of the vertebroplasty group,but there was no statistically significant difference in the operator between two groups.Conclusion:Both puncture methods can achieve satisfactory clinical results,but curved-angle puncture can optimize the distribution of bone cement and reduce the radiation dose of patients.