椎体后上缘入路椎体成形术治疗腰椎骨质疏松性压缩性骨折

Treatment of Lumbar Osteoporotic Vertebral Compression Fractures by Vertebroplasty via the Approach of the Posterior Superior Edge of the Affected Vertebral Body

目的 探究运用椎体后上缘入路椎体成形术(percutaneous vertebroplasty, PVP)治疗腰椎骨质疏松性压缩性骨折(lumbar osteoporotic compression fracture, OVCF)的临床疗效及安全性。方法将2020年6月~2020年12月我科收治的51例腰椎OVCF患者作为研究对象,均采用一种新型入路——经椎体后上缘入路完成PVP手术。记录手术时间、骨水泥注射量、骨水泥分布与渗漏情况,并比较术前、术后腰腿痛视觉模拟评分(visual analogue scale, VAS)及Oswestry功能障碍指数(Oswestry disability index, ODI)评分,随访期间观察近期并发症,包括伤椎再骨折及邻近椎体骨折。结果 51例患者均顺利完成手术,手术时间36~65 min,平均(49.61±6.06)min。骨水泥注入量(2.2~8.4)mL,平均(5.33±1.46)mL。骨水泥在冠状位及横断面的分布均越过中线。18例发生骨水泥渗漏,其中椎管后缘渗漏6例,椎旁渗漏7例,椎间隙渗漏5例,总渗漏率为35.29%。但术中未出现穿刺引起的神经、血管损伤以及骨水泥渗漏引起的神经症状。术前、术后1 d、术后1月及末次随访时的腰腿痛VAS分别为7.61±2.09、 2.76±1.27、 2.04±0.89及2.31±0.47;ODI评分分别为70.29±15.49、 30.98±4.10、 28.41±3.03及30.22±2.34。术后1 d、术后1月、末次随访时的VAS、 ODI评分均较术前明显降低(P<0.01)。随访过程中2例发生邻近椎体骨折,未发现伤椎再骨折病例。末次随访时采用改良MacNab标准评估手术疗效,优良率为94.12%(48/51)。结论 经椎体后上缘入路椎体成形术治疗骨质疏松性腰椎压缩性骨折安全性高,可获得满意疗效,为临床PVP治疗OVCF提供了一种新的入路,但需把握好适应证。

Objective To investigate the clinical efficacy and safety of percutaneous vertebroplasty(PVP) through the posterior upper margin approach in the treatment of lumbar osteoporotic compression fracture(OVCF). Methods 51 patients with lumbar OVCF in our department from June 2020 to December 2020 were included in this study. A new approach for PVP via the posterior superior edge of the affected vertebral body was used to complete the operation. Operation time, the amount of bone cement injection, the distribution and leakage of bone cement were recorded, and the preoperative and postoperative visual analog scores(VAS) and Oswestry disability index(ODI) were compared. The short-term complications were observed during follow-up, including re-fractures of the injured vertebral body or adjacent vertebral body fractures. Results All the 51 patients successfully completed the operation. Operation time was 36~65 minutes, with an average of(49.61±6.06) minutes. The amount of bone cement injected was(2.2~8.4) mL, with an average of(5.33±1.46) mL. The bone cement was distributed across the midline in coronal and cross section. Bone cement leakage occurred in 18 cases,including 6 cases of posterior edge leakage of vertebral canal,7 cases of paravertebral leakage,and 5 cases of intervertebral space leakage. The total leakage rate was 35.29%. However,there was no nerve and vascular injury caused by puncture,nor nerve symptoms caused by bone cement leakage during the operation. VAS before operation,1 day after operation,1 month after operation and at the last follow-up was 7.61±2.09,2.76±1.27,2.04±0.89 and 2.31±0.47 respectively;While ODI scores were 70.29±15.49,30.98±4.10,28.41± 3. 03 and 30. 22 ± 2. 34 respectively. The postoperative VAS and ODI score was significantly lower than that before operation( P<0.01). During the follow-up,there were 2 cases of adjacent vertebral fracture,and no case of the injured vertebral body fracture was found. At the last follow-up,the excellent and good rate was 94.12%( 48/51) according to the modified MacNab criteria. Conclusion The percutaneous vertebroplasty through the posterior superior edge of the affected vertebral body is safe and feasible in the treatment of lumbar osteoporotic vertebral compression fracture,and can obtain satisfactory curative effect and provide a new approach for PVP treatment of lumbar OVCF. However,it is necessary to grasp the indications.