提高骨水泥注入安全性的改良椎体成形术△

Modified vertebroplasty to improve the safety of bone cement injection

摘要:

［目的］ 介绍一项可以提高骨水泥注入安全性的改良椎体成形术 （percutaneous vertebroplasty, PVP） 或后突成形术 （percutaneous kyphoplasty, PKP） 的手术技术和初步临床效果。［方法］ 2015 年 1 月—2020 年 1 月作者采用改良 PVP/PKP 治疗骨质疏松性椎体压缩性骨折 199 例。创新点在于骨折区域靶点穿刺置管、侧口推杆辅助骨水泥靶点注入、椎弓根拖尾锚定 3 项技术整合应用。通过术中透视及术后 X 线片、CT 观察骨水泥弥散填充及泄露情况。［结果］所有患者均顺利完成手术，手术时间单节段平均（1.0±0.3）h，无骨水泥过敏、肺栓塞并发症、手术部位感染等重大并发症发生。单侧穿刺 78 例，双侧穿刺 121 例；骨水泥渗漏 5 例，其中椎间隙渗漏 3 例，椎旁血管渗漏 2 例，均未出现明显临床症状，不需特殊处理。随访 12~30 个月， VAS 评分术前（7.9±1.4）分、术后 1 d（2.6±0.7）分、末次随访时（2.4±0.6）分，疼痛均明显减轻。影像显示病椎前缘高度明显恢复；骨水泥在骨折区域充分弥散填充，椎弓根处锚定稳定。［结论］改良椎体成形术可有效降低骨水泥渗漏、移位及生物毒性的风险，进而提高手术安全性，初步临床疗效满意。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of modified percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) to improve the safety of bone cement injection. [Methods] From January 2015 to January 2020, 199 patients received the modified PVP/PKP for osteoporotic vertebral compression fractures in our departments. The innovation point in- cluded the integrated application of target puncture and catheterization in the fracture area, the lateral push rod assisted bone cement target injection, and pedicle trailing anchoring. The diffusion filling and leakage of bone cement were observed by intraoperative fluoroscopy, post- operative X-ray and CT. [Results] All the patients had operation performed smoothly, with operation time for single segment (1.0±0.3) hour on a mean, whereas without bone cement allergy, pulmonary embolism, surgical site infection and other major complications. Of them, 78 cases got unilateral puncture, while 121 cases got bilateral puncture. There were 5 cases of bone cement leakage, including 3 cases of inter- vertebral space leakage and 2 cases of paravertebral blood vessel leakage, with no obvious clinical symptoms occurred and no special treat- ment was needed. The patients were followed up for 12~30 months, and the VAS score decreased from (7.9±1.4) before surgery, to (2.6±0.7) a day after surgery, and (2.4±0.6) at the last follow-up. The imaging examinations showed that the height of the anterior vertebrae of the af- fected vertebrae recovered obviously, whereas the cement was fully dispersed and filled in the fracture area with stable pedicle anchor. [Conclusion] This modified vertebroplasty does effectively reduce the risk of bone cement leakage, displacement and biological toxicity, thereby improving surgical safety, with satisfactory preliminary clinical outcomes.