基于椎体灌洗阳性的负压引导椎体成形术的应用研究

Application of negative pressure guided vertebroplasty based on positive vertebrolavage

目的 探讨基于椎体灌洗阳性的负压引导椎体成形术的安全性及有效性。方法 回顾性选取椎体灌洗阳性的椎体成形术患者76例,其中行负压引导30例(实验组),未行负压引导46例(对照组)。比较两组患者骨水泥的渗漏、弥散分布,以及术前和术后3 d及3个月的疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)。结果实验组骨水泥渗漏率低于对照组,差异有统计学意义(χ~2=4.83,P<0.05)。实验组骨水泥弥散分布优于对照组,差异有统计学意义(Z=5.03,P<0.05)。两组术后3 d、术后3个月的VAS评分、ODI指数与术前比较均有明显下降,差异均有统计学意义(t分别=46.98、82.19、46.23、80.49,P均<0.05);但实验组术后3 d、术后3个月VAS评分、ODI指数与对照组比较,差异均无统计学意义(t分别=-0.60、-0.53、-0.94、-0.31,P均>0.05)。结论 在椎体灌洗阳性的前提下,负压引导下行椎体成形术相较传统双侧椎体成形术,能显著降低骨水泥的渗漏风险,改善骨水泥在椎体内的弥散分布,使之具有更好的生物力学优势。

Objective To investigate the safety and efficacy of negative pressure guided vertebrolasty based on posi-tive vertebrolavage.Methods A total of 76 patients with positive spondyloplasty were retrospectively selected,including 30 patients who received negative pressure guidance(experimental group)and 46 patients who did not receive negative pressure guidance(control group).Bone cement leakage and diffusion,pain visual analogue scale(VAS)and Oswestry disability index(ODI)were compared between the two groups before surgery,3 days and 3 months after surgery.Results The bone cement leakage rate in the experimental group was lower than that in the control group,the differ-ence was statistically significant(χ2=4.83,P<0.05).The bone cement diffusion of the experimental group was better than that of the control group,and the difference was statistically significant(Z=5.03,P<0.05).VAS score and ODI in-dex of two groups at 3 days and 3 months after surgery were significantly decreased compared with those before surgery,with statistical significance(t=46.98,82.19,46.23,80.49,P<0.05).However,VAS score and ODI index of the experi-mental group were not significantly different from those of the control group at 3 days and 3 months after surgery(t=-0.60,-0.53,-0.94,-0.31,P>0.05).Conclusion Under the premise of positive vertebroplasty,negative pressure guid-ed downward vertebroplasty can significantly reduce the leakage of bone cement and improve the diffusion distribution of bone cement in the vertebroplasty,so that it has better biomechanical advantages.