| 基于OVCFs椎体内骨质致密带的双侧靶向穿刺在经皮椎体成形术中的临床应用 |
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投稿时间：2023-06-24 修订日期：2024-01-05
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| 期刊信息：《中国骨伤》年，第卷，第期，第-页 |
| DOI： |
| 基金项目:创新研究群体科学基金 |
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| 中文摘要:目的：探讨基于椎体内骨质致密带的双侧靶向穿刺行椎体成形术的临床疗效。方法：回顾性分析2021年1月至12月行PVP治疗的伴有椎体内骨质致密带的新鲜症状性骨质疏松性椎体压缩性骨折患者共76例,均为单椎体骨折,其中男性19例,女性57例,年龄62-88岁,平均(68.5±12.5)岁,所有病人均行双侧经椎弓根穿刺。术前根据CT或MRI判断骨质致密带在椎体内的相对位置(即比如骨质致密带为于椎体左或右侧矢状面的中上三分之一或四分之一),分别以致密带的头端及尾端区域作为穿刺靶点,设计穿刺点及路径,建立工作通道,在C型臂X光机监视下缓慢推注骨水泥。记录手术时间、骨水泥量、骨水泥渗漏情况,采用视觉模拟评分(Visual Analogue Scale,VAS)、Osvestry功能障碍指数(ODI)、椎体前壁高度(Anterior Height AH)进行疗效评定。结果：所有患者均顺利完成手术,手术时间(36.57±11.25)min,骨水泥注入量(6.07±1.19)ml,骨水泥渗漏21例,渗漏率27.63%,术后2天有3例VAS评分大于4分,疼痛缓解欠佳,占3.94%。术后2天VAS评分、ODI较术前明显改善,P<0.05,差异有统计学意义；术后2天与末次随访无明显差异。椎体前缘高度术前与术后2天相比较、末次随访与术后2天相比较,差异均无统计学意义,说明术后患者椎体无进行性塌陷。结论：基于椎体内骨质致密带的双侧靶向穿刺在不增加骨水泥渗漏的前提下,可实现双侧对称、顶天立地的全椎体骨水泥强化,取得较好的早期疗效,防止晚期椎体塌陷,对于进一步提高经皮椎体成形术的疗效有积极意义,值得临床推广。 |
| 【关键词】骨质疏松性椎体压缩性骨折 经皮椎体成形术 骨水泥分布 靶向穿刺 |
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| Clinical application of bilateral targeted puncture based on vertebral osteodense zone of osteoporoticvertebral compression fractures in percutaneous vertebroplastyJIA Bao-xi1 JU Jing2 Liu Cheng-zhou1 GaoXiao-qiang1 WANG Ting3 |
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| ABSTRACT Objective:To investigate the clinical efficacy of bilateral targeted puncture for vertebroplasty based on the vertebral osteodense zone。Methods: Retrospective analysis was made on 76 cases of fresh symptomatic osteoporotic vertebral compression fracture with osteodense zone in vertebral body treated with PVP from January to December 2021, all of which were single vertebral fractures, including 19 males and 57 females, aged 62-88 years, with an average of (68.5 ± 12.5) years. All patients were punctured bilaterally through pedicle of vertebral. Before operation, determine the relative position of the osteodense zone of bone in the vertebral body according to CT or MRI (for example, the osteodense zone of bone was one third or one quarter of the upper middle sagittal plane of the left or right vertebral body), so that the head end and tail end of the osteodense zone were used as the puncture target, design the puncture point and path, establish the working channel, and slowly inject bone cement under the monitoring of the C-arm X-ray machine. Record the surgical time, volume of bone cement, and leakage of bone cement, and evaluate the efficacy using Visual Analog Scale (VAS), Oswestry Dysfunction Index (ODI), and Anterior Height (AH) Result: All patients successfully completed the surgery, with a surgical time of (36.57 ± 11.25) minutes and a bone cement injection volume of (6.07 ± 1.19) ml. There were 21 cases of bone cement leakage, with a leakage rate of 27.63%. Three cases had a VAS score greater than 4 points 2 days after surgery, with poor pain relief, accounting for 3.94%. VAS score and ODI were significantly improved 2 days after surgery compared to before, P<0.05, and the difference was statistically significant.There was no significant difference between 2 days after surgery and the last follow-up. There was no statistically significant difference between the last follow-up and 2 days after surgery,and between before and 2 days after surgery in the anterior height of the vertebral body, indicating that there was no progressive vertebral collapse in the patient after surgery. Conclusion:Bilateral targeted puncture based on the osteodense dense zone within the vertebral body can achieve bilateral symmetrical and upright full vertebral bone cement reinforcement without increasing bone cement leakage, achieving good early efficacy and preventing late vertebral collapse. This has positive significance for further improving the efficacy of percutaneous vertebroplasty and is worthy of clinical promotion. |
| KEY WORDS Osteoporotic Vertebral Compression Fractures Percutaneous Vertebroplasty Bone cement distribution Targeted puncture |
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