经皮双层面双侧穿刺行经皮椎体成形术治疗伴有致密骨带的骨质疏松性胸腰椎骨折新分型ⅡA型骨折的疗效分析

Percutaneous vertebroplasty by percutaneous bi-level bilateral puncture for treatment of typeⅡA acute symptomatic osteoporotic thoracolumbar fractures with dense bone bands

目的探讨经皮双层面双侧穿刺行经皮椎体成形术(PVP)治疗伴有明显致密骨带的骨质疏松性胸腰椎骨折新分型(ASOTLF)ⅡA型骨折的疗效。方法回顾性分析2017年3月至2018年3月青岛市中心医院创伤骨科收治的65例(65个椎体)伴有明显致密骨带的ASOTLFⅡA型患者资料。男25例,女40例;年龄(71.6±8.4)岁;受伤至手术时间(3.5±0.7)d。根据治疗方法不同分为两组:观察组31例(31个椎体)采用双层面双侧穿刺行PVP,对照组34例(34个椎体)采用单层面双侧穿刺行PVP。比较两组患者手术时间、骨水泥注入量、骨水泥渗漏率、椎体再骨折率、骨水泥在椎体中的扩散分布情况,以及术后1 d、6个月疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。65例患者均成功完成手术,随访时间为(8.2±1.2)个月。两组患者每个伤椎的手术时间、骨水泥渗漏率、椎体再骨折率比较差异均无统计学意义(P>0.05)。观察组骨水泥注入量[(6.64±0.93)mL]显著多于对照组[(4.36±0.79)mL],骨水泥在椎体中扩散分布优良率87.1%(27/31)显著高于对照组64.7%(22/34),差异均有统计学意义(P<0.05)。观察组术后1 d、6个月VAS评分[2(1,2)、1(1,2)分]和ODI(23.7%±1.6%、18.8%±1.4%)均显著低于对照组[2(2,3)、2(2,2)分和26.9%±4.2%、22.1%±3.3%],差异均有统计学意义(P<0.05);所有患者术后1 d、6个月VAS评分和ODI均显著低于术前,差异均有统计学意义(P<0.05)。所有患者术后均无脊髓、神经根受压症状。结论经皮双层面双侧穿刺行PVP作为一种治疗伴有明显致密骨带的ASOTLFⅡA型骨折方法,较传统的经皮单层面双侧穿刺行PVP疗效更好,且不会增加骨水泥渗漏率或椎体再骨折率。

Objective To evaluate the efficacy of percutaneous vertebroplasty(PVP)by percutaneous bi-level bilateral puncture in the treatment of typeⅡA acute symptomatic osteoporotic thoracolumbar fracture(ASOTLF)with dense bone bands.Methods From March 2017 to March 2018,65 patients(65 vertebrae)with typeⅡA ASOTLF with dense bone bands were treated at Department of Orthopaedic Trauma,Qingdao Central Hospital.They were 25 males and 40 females,with an age of(71.6±8.4)years.The time from injury to operation was(3.5±0.7)d.They were divided into 2 groups according to different treatments.In the observation group of 31 cases(31 vertebrae),PVP was conducted by percutaneous bi-level bilateral puncture;in the control group of 34 cases(34 vertebrae),PVP was conducted by percutaneous single-level bilateral puncture.The 2 groups were compared in terms of operation time,volume of polymethyl methacrylate injected,incidence of bone cement leakage,incidence of vertebral refracture,diffusive distribution of bone cement in the vertebral body,and visual analogue scale(VAS)and Oswestry dysfunction index(ODI)at postoperative 1 day and 6 months.Results There was no significant difference in the preoperative general data between the 2 groups,showing comparability(P>0.05).Operations were completed uneventfully in all the 65 patients.All the 65 patients were followed up for(8.2±1.2)months.There was no significant difference between the 2 groups in operation time,incidence of bone cement leakage or incidence of vertebral refracture for each vertebral body injured(P>0.05).The volume of polymethyl methacrylate injected[(6.64±0.93)mL]and the excellent and good rate of diffusive distribution of bone cement in the vertebral body[87.1%(27/31)]in the observation group were significantly larger than those in the control group[(4.36±0.79)mL and 64.7%(22/34)](P<0.05).The VAS scores at postoperative 1 day and 6 months[2(1,2)and 1(1,2)]and ODIs at postoperative 1 day and 6 months(23.7%±1.6%and 18.8%±1.4%)in the observation group were significantly lower than those in the control group[2(2,3)and 2(2,2);26.9%±4.2%and 22.1%±3.3%](P<0.05).The VAS scores and ODIs at postoperative 1 day and 6 months in all patients were significantly lower than those before operation(P<0.05).Compression symptoms of the spinal cord and nerve root were observed in none of the patients.Conclusion In the treatment of typeⅡA ASOTLF with dense bone bands,PVP by percutaneous bi-level bilateral puncture is more effective than the traditional PVP by percutaneous single-level bilateral puncture,and will not increase bone cement leakage or vertebral refracture.