三种防止骨水泥渗漏椎体增强术比较

Comparison of three percutaneous vertebral augmentations to prevent cement leakage

摘要:

[目的]比较经皮椎体增强（percutaneous vertebral augmentation, PVA）术治疗老年椎体骨折的疗效。[方法]回顾性分析本院 2020 年 1 月—2022 年 12 月采用 PVA 治疗 80 例老年骨质疏松性椎骨压缩骨折（osteoporotic vertebral compression frac- ture, OVCF）。其中，20 例采用后凸成形术 （percutaneous kyphoplasty, PKP），30 例采用分次经皮椎体成形术 （percutaneous ver- tebroplasty, PVP），30 例采用海绵 PVP。比较三组临床与影像学资料。[结果]三组患者均顺利手术，海绵组发生 1 例骨水泥渗漏。手术时间由高至低依次为 PKP 组 ＞分次组＞海绵组，差异有统计学意义 [(42.2±4.5) min vs (35.4±4.0) min vs (28.9±3.2) min, P＜ 0.001]。骨水泥注入量依次为 PKP 组＞分次组＞海绵组，差异有统计学意义 [(5.8±0.4) ml vs (5.4±0.5) ml vs (4.9±0.6) ml, P=0.001]。 PKP 组手术费用最高，显著高于其他两组（P＜0.05）。随时间推移，三组患者的 VAS 及 ODI 评分均有明显下降（P＜0.05）。术后 1 d VAS 评分依次为 PKP 组＞分次组 ＞ 海绵组，差异有统计学意义 [(2.0±0.8) vs (1.2±0.8) vs (1.0±0.6), P＜0.001]。影像方面，PKP 组后凸角的矫正度显著优于其他两组 [(7.4±0.9) vs (5.3±1.0) vs (5.1±0.5), P＜0.001]。与术前相比，术后三组椎体前缘高度均显著增加（P＜ 0.05）。[结论]三组手术技术各其优缺点，PKP 适用于需要恢复后凸畸形的患者，但花费较高；分次组在三组手术中在各个数据中较均衡；海绵组手术方式简单，手术时间短，但仍为有一定的渗漏风险。

Abstract:

[Objective] To compare the anti-cement-leakage efficacy of three percutaneous vertebral augmentations (PVA) in the treat- ment of osteoporotic vertebral compression fracture (OVCF) in the elderly. [Methods] A retrospective study was done on 80 patients who re- ceived PVA for OVCF from January 2020 to December 2022. Of them, 20 patients received percutaneous kyphoplasty (PKP), 30 patients re- ceived PVP with fractionated cement injection (FCI), while the remaining 30 patients received PVP following sealing by gelatin sponge (SGS). Clinical and imaging data of the three groups were compared. [Results] All patients in the three groups were operated on successfully, with a case of bone cement leakage occurred in the SGS group. The operative time was ranked from high to low as PKP group ＞ FCI group ＞ SGS group with statistically significant differences [(42.2±4.5) min vs (35.4±4.0) min vs (28.9±3.2) min, P＜0.001]. The injection amount of bone cement was arranged up-down as PKP group ＞ FCI group ＞ SGS group with statistically significant differences [(5.8±0.4) ml vs (5.4± 0.5) ml vs (4.9±0.6) ml, P=0.001]. The PKP group had the highest hospital expense, which was significantly higher than that of the other two groups (P＜0.05). The VAS and ODI scores significantly decreased over time in all the 3 groups (P＞0.05), of which the VAS scores 1 day after surgery were of PKP group ＞FCI group＞SGS group with statistically significant differences [(2.0±0.8) vs (1.2±0.8) vs (1.0±0.6), P＜0.001]. Ra- diographically, PKP group got significantly better kyphotic correction than the other two groups [(7.4±0.9)° vs (5.3±1.0)° vs (5.1±0.5)°, P＜ 0.001]. However, the anterior height of the affected vertebrae increased significantly in all three groups after surgery (P＜0.05). [Conclusion] The three surgical techniques have their own advantages and disadvantages. PKP is suitable for patients who need to correct kyphosis with high financial cost, the PVP with fractioned injection is more balanced in all data among the three groups of operations, while the PVP with sealing by gelatin sponge is simple in operation with short operation time, but a certain risk of cement leakage.