不同穿刺方法注入骨水泥在骨质疏松椎体压缩性骨折中的应用研究

Application of different puncture techniques to inject bone cement in osteoporotic vertebral compression fractures

目的:研究不同穿刺方法注入骨水泥在骨质疏松椎体压缩性骨折(osteoporosis vertebral compression fractures,OVCFs)的临床应用。方法:对2017年1月至2019年12月收治的282例OVCFs患者进行回顾性研究,根据手术方案分为A、B两组,每组141例。A组采取极外侧穿刺法经单侧穿刺、双侧注入骨水泥,B组采取椎弓根入路单侧穿刺注入骨水泥。观察两组手术情况(手术时间、射线暴露时间、骨水泥注入量、住院时间)和并发症,比较术前和术后6、12个月疼痛介质,包括5羟色胺(5-hydroxytryptamine,5-HT)、前列腺素E2(prostaglandin E2,PGE2)、P物质(substance P,SP),以及骨密度水平、伤椎解剖参数(椎体前缘高度、椎体后缘高度、Cobb角)、视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)。结果:两组手术时间、射线暴露时间、住院时间比较差异均无统计学意义(P>0.05),A组骨水泥注入量大于B组(P<0.05)。术后12个月A组血清5-HT、SP、PGE2水平低于B组(P<0.05);术后12个月A组椎体前缘高度、椎体后缘高度大于B组,Cobb角小于B组,VAS、ODI低于B组(P<0.05);术后6、12个月两组骨密度比较差异均无统计学意义(P<0.05)。术后并发症两组差异无统计学意义(P>0.05)。结论:与椎弓根入路单侧穿刺法比较,极外侧穿刺法经单侧穿刺、双侧注入骨水泥技术更有利于伤椎解剖结构和功能恢复,且不延长手术时间、射线暴露时间、住院时间,也不增加神经损伤、骨水泥渗漏风险,术后骨代谢及骨密度改善良好,是治疗OVCFs的安全可靠术式。

Objective To study the application of different puncture techniques to inject bone cement in osteoporotic vertebral compression fractures(OVCFs).Methods The clinical data of 282 patients with OVCFs treated from January 2017 to December 2019 were collected for a retrospective study.According to the surgical plan the patients were divided into group A and B,with 141 cases in each group.In group A,extreme lateral puncture was used to inject bone cement through unilateral puncture and bilateral puncture.In group B,bone cement was injected through unilateral pedicle puncture through pedicle approach.The operation status(operation time,radiation exposure time,bone cement injection volume,hospital stay)and complications were observed between two groups.Before operation and 6,12 months after operation,the pain mediators such as serotonin 5-hydroxytryptamine(5-HT),prostaglandin E2(PGE2),substance P(SP)were compared,bone mineral density,anatomical parameters of the injured vertebrae(height of the anterior edge of the vertebral body,height of the posterior edge of the vertebral body,Cobb angle),visual analogue scale(VAS)and Oswestry disability index(ODI)were evaluated between two groups.Results There were no significant difference in operation time,radiation exposure time,hospital stay between two groups(P>0.05).The amount of bone cement injected in group A was greater than that in group B(P<0.05).The serum 5-HT,SP and PGE2 levels of group A were lower than those of group B at 12 months after operation(P<0.05).The height of anterior edge and height of the posterior edge of vertebral body in group A were greater than those of group B at 12 months after operation,Cobb angle of group A was smaller than that of group B,VAS and ODI were lower than those of group B(P<0.05).There was no significant difference in bone mineral density between two groups at 6 and 12 months postoperatively(P<0.05).There was no significant difference between two groups in postoperative complications(P>0.05).Conclusion Compared with unilateral puncture of the pedicle approach,unilateral puncture and bilateral cement injection technique is more conducive to the recovery of the injured vertebral anatomy and function,and do not prolong operation time,radiation exposure time,hospital stay,nor do increase the risk of nerve damage and bone cement leakage,and postoperative bone metabolism and bone mineral density are improved well,which is a safe and reliable surgical method for the treatment of OVCFs.