术前测量联合术中精准穿刺经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折的疗效分析

李彦飞; 霍喜卫; 李东风; 胡成栋; 王飞; 李海涛

doi:10.13898/j.cnki.issn.1000-2200.2021.10.015

术前测量联合术中精准穿刺经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折的疗效分析

Clinical effects of the preoperative measurement combined with intraoperative precise puncture percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fractures

摘要

摘要:
目的探讨术前测量联合术中精准穿刺经皮椎体后凸成形术（PKP）治疗骨质疏松性椎体压缩骨折的可行性及临床疗效。
方法回顾性分析行PKP治疗的98例单节段骨质疏松性椎体压缩骨折病人的临床资料，其中有85例病人获得超过1年的临床随访，根据术中通道建立方法将病人分为2组：观察组47例，采用术前图像测量确定穿刺角度及进针轨迹联合术中精准穿刺PKP治疗；对照组38例，采用常规PKP治疗。观察并比较2组病人手术时间、术中透视次数、伤椎高度恢复、术后骨水泥分布及渗漏发生情况，以视觉模拟评分（VAS）和Oswestry功能障碍指数（ODI）评价疼痛缓解及生活质量改善情况。
结果观察组在手术时间及术中透视次数上均低于对照组，骨水泥弥散至中线比例高于对照组，差异有统计学意义（P < 0.05~P < 0.01）；2组术中骨水泥注入量比较差异无统计学意义（P>0.05）；术后2组病人VAS评分和ODI指数均较术前降低，伤椎平均高度和局部Cobb角均有明显恢复，差异具有统计学意义（P < 0.01）；不同时间点2组VAS评分、ODI指数伤椎平均高度和局部Cobb角比较，差异均无统计学意义（P>0.05）；术后CT扫描发现，观察组骨水泥渗漏发生率为8.5%（4/47），对照组骨水泥渗漏率为21.0%（10/38），2组渗漏率比较差异有统计学意义（P < 0.05）。
结论术前图像测量联合术中精准穿刺法可以提高穿刺的准确性，减少手术时间及术中透视次数，使骨水泥更好地弥散超过中线，且骨水泥的渗漏率更低。

Abstract:
ObjectiveTo observe the feasibility and clinical effects of preoperative measurement combined with intraoperative precise puncture percutaneous kyphoplasty(PKP) in the treatment of osteoporotic vertebral compression fractures.
MethodsThe clinical data of 98 single-segment osteoporotic vertebral compression fractures patients treated with PKP were retrospective analyzed.Eighty-five patients were followed up for more than 1 year.According to the puncture method during operation, the patients were divided into the observation group(47 cases) and control group(38 cases).The observation group and control group were treated with preoperative image measurement combined with precise puncture PKP and conventional PKP, respectively.The operative time, number of intraoperative fluoroscopy, recovery of injured vertebral height, postoperative bone cement distribution and leakage were compared between two groups.The pain relief and quality of life improvement in two groups were evaluated using visual analog scale(VAS) and Oswestry disability index(ODI).
ResultsThe operation time and intraoperative fluoroscopy times in observation group were lower than those in control group, and the proportion of bone cement diffusion to the midline in observation group was higher than that in control group(P < 0.05 to P < 0.01).The difference of the amount of intraoperative bone cement injection between two groups was not statistically significant(P>0.05).After surgery, the VAS score and ODI in two groups decreased, the mean height of injured vertebrae and local Cobb angle were significantly recovered compared with those before surgery, and the difference of which was statistically significant(P < 0.01).The differences of the VAS score, ODI, average height of injured vertebrae and local Cobb angle between two groups at different time points were not statistically significant(P>0.05).The results of postoperative CT scan showed that the incidence rates of bone cement leakage in the observation group and control group were 8.5%(4/47) and 21.0%(10/38), respectively, and the difference of which was statistically significant(P < 0.05).
ConclusionsThe preoperative image measurement combined with precise puncture during the PKP can improve the accuracy of vertebral puncture, reduce the operative time and fluoroscopy times.Moreover, it makes the bone cement better diffuse over the midline, and leakage rate of bone cement decrease.

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