同种异体骨防止椎体成形术中骨水泥渗漏

Bone allografting for prevention of bone cement leakage during percutaneous vertebroplasty

[目的]介绍同种异体骨防止椎体成形术中骨水泥渗漏的手术技术和初步临床效果。[方法]2017年6月-2019年6月,采用椎体成形术治疗老年人胸腰椎爆裂性骨折27例,C形臂X线机透视定位伤椎双侧椎弓根穿刺点后,建立工作通道,通过工作导管向伤椎填塞同种异体骨颗粒,再注射PMMA骨水泥填充,采用疼痛视觉模拟量表(VAS)评分、功能障碍指数(0DI),以及影像测量椎体高度和Cobb角评价临床效果,记录骨水泥注射量及渗漏率。[结果]27例患者均顺利完成手术,骨水泥渗漏3例,骨水泥渗漏率11.11%。所有患者术后均未出现穿刺部位感染、肺栓塞、骨水泥向椎管内渗漏以及神经损伤等并发症。术后所有患者胸、腰部疼痛明显缓解,椎体高度、Cobb角、VAS评分、0DI评分及活动能力均较术前改善,差异均具有统计学意义(P<0.05)。[结论]PVP治疗老年人椎体爆裂性骨折可以有效快速缓解疼痛,术中应用同种异体骨对骨水泥渗漏具有一定的预防作用。

[Objective]To introduce the surgical technique and preliminary clinical results of bone allografting to prevent bone cement leakage during percutaneous vertebroplasty(PVP).[Methods]From June 2017 to June 2019,27 elderly patients underwent PVP for thoracolumbar burst fractures in our hospital.After the bilateral pedicle punctures were conducted successfully under monitoring by C-arm fluoroscopy,working channels were established.Bone allografts in granule were filled into the fractured vertebral body through the channels,followed by injection of PMMA bone cement.The visual analogue scale(VAS)for pain and Oswestry dysfunction index(ODI)as well as vertebral body height and local Cobb angle measured on radiographs were used to evaluate the clinical consequences,additionally,the bone cement injection volume and leakage rate were recorded.[Results]All the 27 patients had operation completed successfully,and only 3 cases had bone cement leakage found,with the bone cement leakage rate of 11.11%.There were no complications,such as puncture site infection,pulmonary embolism,leakage of bone cement into the spinal canal,and nerve injury,in anyone of them.The chest and waist pain significantly relieved after operation in all of them.In addition,the VAS and ODI scores,as well as vertebral body height and local Cobb angle measured on radiographs significantly improved postoperatively compared with those preoperatively(P<0.05).[Conclusion]The PVP does effectively and quickly relieve pain of vertebral burst fractures in the elderly,and intraoperative bone allografting has a certain preventive effect on bone cement leakage.