精准靶点单侧入路PVP治疗骨质疏松性胸腰椎压缩性骨折的临床疗效分析

Clinical analysis of accurate target unilateral approach PVP in the treatment of osteoporotic thoracolumbar compression fracture

摘要:

[目的]对比精准靶点单侧入路与常规单侧入路经皮椎体成形术（percutaneous vertebroplasty, PVP）治疗骨质疏松性胸腰椎压缩性骨折（osteoporotic vertebral compression fracture, OVCF）的临床疗效。[方法]2020年1月-2022年6月，在本院接受PVP手术的72例OVCF患者，根据术前医患沟通结果，36例采用精准靶点单侧入路PVP（精准组），36例接受常规单侧入路PVP（常规组），比较两组围手术期、随访和影像学资料。[结果]两组患者手术均顺利完成，骨水泥渗漏精准组发生14例，常规组发生18例，均未发生严重并发症。精准组手术时间、术中透视次数、穿刺针调整次数均显著低于常规组（P<0.001），骨水泥注入量高于常规组（P<0.001），骨水泥弥散度优于常规组（P<0.05）。两组骨水泥渗漏率、下地行走时间、住院时间、术前VAS评分、ODI评分、JOA评分差异无统计学意义（P＞0.05）。两组患者均获随访，随访时间13-16个月，平均（15.5±0.4）个月。两组完全负重活动时间的差异无统计学意义（P>0.05），随时间推移，两组的VAS 评分、ODI 指数降低 （P<0.001），JOA评分增加（P<0.001）；同一时间点内，两组患者术后VAS 评分、ODI 指数、JOA评分差异均无统计学意义（P＞0.05）。与术前比较，术后2 d椎体前缘高度增高、局部后凸Cobb 角减小（P<0.001）；与术后2 d比较，末次随访时椎体前缘高度有所丢失、局部后凸Cobb 角略微增大，但差异无统计学意义（P＞0.05）。同一时间点两组间椎体前缘高度及局部后凸Cobb 角的差异均无统计学意义（P＞0.05）。[结论]精准靶点单侧入路PVP治疗OVCF疗效满意，且具有穿刺路径精准、术中射线暴露量低、组织损伤小、骨水泥双侧弥散充分等优势，但存在一定的学习曲线。

Abstract:

[Objective]To compare the clinical effects of accurate target unilateral approach and conventional unilateral approach percutaneous vertebroplasty (percutaneousvertebroplasty,PVP) in the treatment of osteoporotic thoracolumbar compression fracture (osteoporotic vertebral compression fracture,OVCF). [Methods]From January 2020 to June 2022, 72 patients with OVCF underwent PVP in our hospital. According to the results of preoperative doctor-patient communication, 36 patients received accurate target unilateral approach PVP (precision group) and 36 patients received conventional unilateral approach PVP (routine group). The perioperative period, follow-up and imaging data of the two groups were compared.?[Results]The operations were completed successfully in both groups. Bone cement leakage occurred in 14 cases in the accurate group and 18 cases in the routine group, and no serious complications occurred. The operation time, the times of X-ray exposures and needle adjustment in the precision group were significantly lower than those in the routine group(P < 0.001), the amount of bone cement injected in the precision group was higher than that in the routine group(P < 0.001), and the dispersion of bone cement in the precision group was better than that in the routine group(P < 0.001). There was no significant difference in bone cement leakage rate, walking time, hospital stay, VAS score, ODI score and JOA score between the two groups. Patients in both groups were followed up for 13-16 months with an average of (15.5 ± 0.4) months. There was no significant difference in the time of complete weight-bearing activity between the two groups (P > 0.05).With the passage of time, the VAS score and ODI score decreased (P < 0.001), while the JOA score increased (P < 0.001). At the same time, there was no significant difference in VAS score, ODI score and JOA score between the two groups (P > 0.05). Compared with those before operation, the height of the anterior edge of vertebral body increased and the Cobb angle of local kyphosis decreased 2 days after operation (P < 0.001), while the height of anterior edge of vertebral body was lost and the Cobb angle of local kyphosis slightly increased at the last follow-up, but the difference was not statistically significant (P > 0.05). There was no significant difference in the height of anterior edge of vertebral body and Cobb angle of local kyphosis between the two groups at the same time point (P > 0.05).[Conclusion]Accurate target unilateral approach PVP is effective in the treatment of OVCF, and it has the advantages of accurate puncture path, low X-ray exposures, small tissue injury and sufficient bilateral diffusion of bone cement, but there is a certain learning curve.