经皮骨水泥椎间盘成形术治疗老龄真空征型的椎间不稳症患者的临床疗效

Clinical study of percutaneous cement discoplasty for treating elderly patients with vacuum phenomenon-associated lumbar instability

目的探讨经皮骨水泥椎间盘成形术(percutaneous cement discoplasty,PCD)对患有椎间不稳且影像学上伴有真空征的老年患者的临床治疗效果。方法回顾性分析研究中心于2019年6月至2022年9月收治的27例椎间不稳且影像学伴真空征的患者,对其采用PCD手术治疗。记录患者手术时间、骨水泥用量、术中出血及住院总时间。通过比较患者术前及术后VAS评分、ODI指数及腰椎JOA评分来评价患者疼痛及腰椎功能状况的改善。同时,通过术前及术后影像学资料比较患者的椎间隙高度的改变并统计椎间隙截面骨水泥分布率。结果27例行PCD手术的患者均得到有效随访。患者平均住院时间(4.2±1.85)d,手术时间单节段(32.3±4.51)min、双节段(53.6±12.17)min、三节段(74.4±6.33)min、四节段(90.0±10.36)min,术中出血量(6.11±4.97)mL,较传统椎间融合术有明显降低。患者术后VAS疼痛评分及腰椎功能的ODI及JOA评分均较术前有明显改善,脊椎功能得到部分恢复。影像学方面,术后患者椎间隙高度较术前改善,同时操作节段椎间隙中切面骨水泥弥散相对良好。脊柱的力学稳定性得到恢复。结论对于合并严重并发症不适宜行开放手术的患者,PCD是一种可待选择的治疗方案。

Objective To investigate the clinical efficacy and significance of percutaneous cement discoplasty(PCD) in treating elderly patients with spinal instability and vacuum phenomenon on imaging.Methods We retrospectively analyzed 27 patients with spinal instability and vacuum phenomenon on imaging who underwent PVABC between June 2019 and September 2022.We recorded the surgery duration,bone cement usage,intraoperative bleeding,and total hospitalization time.We evaluated the improvement in pain and lumbar function by comparing pre-and postoperative visual analog scale(VAS) scores,Oswestry Disability Index(ODI) scores,and lumbar Japanese Orthopedic Association(JOA) scores.We also compared the change in intervertebral height and the distribution rate of bone cement in the intervertebral space by pre-and postoperative imaging data.Results All the 27 patients who underwent PCD had effective follow-up.The mean hospitalization time was(4.2±1.85) days,and the mean surgery duration was(32.3±4.51),(53.6±12.17),(74.4±6.33),and(90.0±10.36) minutes for single-,double-,triple-,and quadruple-level procedures,respectively.The intraoperative bleeding volume ranged from 2 to 13 mL,which was significantly lower than that of traditional intervertebral fusion surgery.Postoperative VAS pain scores,ODI scores,and JOA scores were significantly improved compared to those before surgery.In terms of imaging,the intervertebral height of the patients improved after surgery,and the distribution of bone cement in the intervertebral space was relatively good in the operated segments.Mechanical stability of the spine was restored.Conclusion For patients who are not suitable for open surgery due to severe complications,PCD is a feasible treatment option.