胸腰椎骨质疏松性骨折精准靶点经皮椎体成形术△（开放获取）

Accurately targeted percutaneous vertebroplasty for thoracolumbar osteoporotic fractures

摘要:

[目的]对比单侧入路精准靶点与常规经皮椎体成形术（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]回顾性分析 2020 年 1 月—2022 年 6 月在本院接受 PVP 手术的 72 例 OVCF 患者的临床资料，根据医患沟通结果，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，均未发生严重并发症。精准组手术时间 [(28.9±3.3) min vs (46.2±9.1) min, P＜0.001]、术中透视次数 [(13.2±1.0) 次 vs (17.1±2.6) 次, P＜0.001]、穿刺针调整次数 [(3.3±6.5) 次 vs (4.8±6.5) 次, P＜0.001] 均显著少于常规组，但前者骨水泥注入量显著多于后者 [(6.3±1.0) ml vs (5.6±0.9) ml, P＜ 0.001]，前者骨水泥弥散度显著优于后者 [I/II/III, (3/16/17) vs (8/22/6), P=0.004]。两组骨水泥渗漏率、下地行走时间、住院时间的差异无统计学意义（P＞0.05）。随访时间（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 、ODI 、JOA 评分均显著改善（P＜0.05）；同一时间点，两组上述指标的差异均无统计学意义（P＞0.05）。影像方面， 两组术后椎体前缘高度和局部后凸 Cobb 均较术前显著改善（P＜0.05），同一时间点，两组间上述影像指标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 outcome of accurately targeted (AT) unilateral percutaneous vertebroplasty (PVP) versus the routine counterpart for osteoporotic vertebral compression fractures (OVCF). [Methods] A retrospective analysis was performed on 72 patients who underwent PVP surgery for OVCF in our hospitals from January 2020 to June 2022. According to the surgeon-patient communication, 36 patients received the AT unilateral PVP, while other 36 patients received the routine unilateral PVP. Perioperative period, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups got corresponding surgical operation completed smoothly without serious complications. The AT group was significantly less than the routine group in terms of operation time [(28.9±3.3) min vs (46.2±9.1) min, P＜0.001], intraoperative fluoroscopy times [(13.2±1.0) times vs (17.1±2.6) times, P＜0.001] and puncture needle adjustment times [(3.3±6.5) times vs (4.8±6.5) times, P＜0.001], while the former got significantly greater bone cement injection volume [(6.3±1.0) ml vs (5.6±0.9) ml, P＜0.001], with significantly better bone cement distribution than the latter [I/II/III, (3/16/17) vs (8/22/6), P=0.004]. There were no significant differences in bone cement leakage rate, walking time and hospital stay between the two groups (P＞0.05). As time elapsed in follow-up period lasted for (15.5±0.4) months, the VAS, ODI and JOA scores in both groups were significantly improved (P＜0.05), whereas which were not statistically significant between the two groups at any time points accordingly (P＞0.05). Regarding imaging, the anterior vertebral height and local kyphotic Cobb angle were significantly improved in both groups after surgery compared with those preoperatively (P＜0.05), while which were not statistically significant between the two groups at any matching time points (P＞0.05). [Conclusion] This accurately targeted unilateral percutaneous vertebroplasty achieves satisfactory consequence for osteoporotic vertebral compression fractures, with advantages of accurate puncture path, low intraoperative radiation exposure, minimized tissue damage, and sufficient bilateral bone cement distribution, despite of a certain learning curve.