摘要
目的探讨单侧穿刺高黏度骨水泥经皮椎体成形术(PVP)治疗Ⅰ型陈旧性症状性骨质疏松性椎体压缩骨折(CSOVCF)的临床疗效。方法采用回顾性病例对照研究分析2013年12月至2016年12月西安交通大学附属红会医院收治的119例Ⅰ型CSOVCF患者临床资料,其中男42例,女77例;年龄58~95岁[(79.2±15.6)岁]。骨密度T值为-4.5~-2.5 SD[(-3.9±O.2)SD].损伤节段:L1-L2 56例,L3~L5 63例。其中60例接受横突与上关节突移行部单侧穿刺高黏度骨水泥PVP治疗(单侧入路组).59例接受Magerl法经椎弓根双侧穿刺高黏度骨水泥PVP治疗(双侧入路组)。比较两组手术时间、骨水泥注入量、术中暴露辐射次数,以及术前、术后1 d及末次随访时视觉模拟评分(VAS)、Oswestry功能障碍指数(0DI)、伤椎前缘高度比、后凸Cobb角;观察邻近椎体骨折、骨水泥渗漏及其他并发症情况。结果患者均获随访12-48个月[(24.1±5.6)个月]。单侧入路组手术时间[(21.5±6.5)min]明显短于双侧入路组[(37.8±7.4)min],骨水泥注入量[(4.2±0.7)ml]少于双侧入路组[(6.5±1.1)ml],术中暴露辐射次数[(14.2±3.0)次]少于双侧入路组[(31.4±6.4)次](P<0.05)。两组术后1 d及末次随访时VAS、ODI、伤椎椎体高度比和后凸Cobb角均较术前明显改善(P<0.05),术后相同时相点两组间差异均无统计学意义(P>0.05)。邻近椎体骨折发生率单侧入路组与双侧入路组分别为5%(3/60)、8%(5/59)(P>0.05)。骨水泥渗漏单侧入路组4例(7%),双侧入路组11例(19%)(P<0.05).患者均未出现伤口感染、神经损伤、肺栓塞等并发症。结论与Magel法经椎弓根双侧穿刺高黏度骨水泥PVP比较,横突与上关节突移行部单侧穿刺高黏度骨水泥PVP治疗I型CSOVCF具有手术时间短、创伤小、术中暴露辐射次数少、术中骨水泥渗漏率低等优点。
Objective To evaluate the efcacy of unilateral puncture techniques in high-viscosity cement percutanueous vertebroplasty(PVP)in treatment of type Ⅰ chronic symptomatic osteoporotic vertebral compression fracture(CSOVCF).Methods A retrospective case control study was conducted to analyze the clinical data of 119 patients with type Ⅰ CSOVCF admitted to Honghui Hospital afiliated to Xi'an Jiaotong University School of Medicine from December 2013 to December 2016.There were.42 males and 77 females,aged 58-95 years[(79.2±15.6)years].All patients had bone mineral densityof-4.5--2.5SD[(-3.9±0.2)SD](T score).The fractured segments included L-12 in 56 patients and Lg-ls in 63.All patients were treated by high-viscosity cement PVP with the unilateral puncture of transverse process and superior articular process in unilateral group(n=60)and by the bilateral puncture approach with the Magerl method in bilaleral group(n=59).The operation time,cement injection volume,and intraoperative fluoroscopy frequency were recorded.The visual analogue scale(VAS),Oswestry dysfunction index(ODI),anterior height ratio of injured vertebrae and Cobb angle were measured before operation,at postoperative Ⅰ day and at the last fllow-up.The adjacent vertebral fracture,cement leakage and other complications were recorded.Results All patients were followed up for 12-48 months[(24.1±5.6)months].The operation time in unilateral group[(21.5±6.5)minutes]was signifcantly shorter than that in bilateral group[(37.8±7.4)minutes](P<0.05).The cement injection volume in unilateral group[(4.2±0.7)ml]was less than that in bilateral group[(6.5±1.1)ml](P<0.05).The intraoperative fuoroscopy frequency in unilateral group[(14.2±3.0)times]was less than that in bilateral group[(31.4±6.4)times](P<0.05).Both groups showed significant improvements in VAS,ODI,anterior height ratio of injured vertebrae and Cobb angle at postoperative 1 day and at the last fllow-up compared with these before operation(P<0.05),but there were no significant differences after op
作者
尹新华
郝定均
林斌
刘仲凯
闫亮
杨小彬
惠华
高林
贺宝荣
Yin Xinhua;Hao Dingjun;Lin Bin;Liu Zhongkai;Yan Liang;Yang Xiaobin;Hui Hua;Gao Lin;He Baorong(Department of Spine Surgery,Honghui Hospital,Xi'an Jiaotong University,Xi'an 710054,China;Department of Orthopedics,909th Hospital of Joint Logistics Support Force of PLA,Zhangzhou 363000,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2021年第4期326-332,共7页
Chinese Journal of Trauma
基金
陕西省科技厅自然科学研究基金(2019JM-200)。
关键词
脊柱骨折
骨质疏松
经皮椎体成形术
Spinal fractures
Osteoporosis
Percutaneous vertebroplasty
