数字化辅助与传统技术经皮椎体成形术的比较△

Percutaneous vertebroplasty by digital assistance versus traditional techniques for osteoporotic vertebral compression frac⁃ tures

摘要:

［目的］评价数字化技术辅助经皮椎体成形（percutaneous vertebroplasty, PVP）治疗胸腰椎骨质疏松性椎体压缩骨折 （osteoporotic vertebral compression fractures, OVCF） 的临床效果。［方法］ 2019 年 1 月—2020 年 8 月的 73 例单节段 OVCF 患者纳入本研究，采用随机数字法分成两组。其中，36 例术前行三维数字化建模及数据测量，行数字辅助单侧 PVP；另外 37 例行传统 PVP。比较两组围手术期、随访及影像资料。［结果］两组患者均顺利完成手术，无严重并发症。数字组手术时间、穿刺时间、术中透视次数均显著优于传统组 （P<0.05）。两组骨水泥注入量及骨水泥渗漏发生率、下地行走时间、完全负重时间的差异无统计学意义 （P>0.05）。两组随访时间平均 （19.33±4.65） 个月，随时间推移，两组术后 VAS、ODI 评分均显著减少，而 JOA 评分显著增加 （P<0.05）；术后 3 d，数字组 VAS、ODI、JOA 评分均显著优于传统组 （P<0.05）。影像方面，与术前相比，两组术后椎体前缘高度均显著增加 （P<0.05），而 C o bb 角均显著减小 （P<0.05）；相应时间点两组间影像测量指标的差异均无统计学意义 （P>0.05）。［结论］与传统 PVP 相比，数字化技术辅助 PVP 可提高胸腰椎经皮椎弓根穿刺的精准性，减少 X 线透视次数及手术时间，且临床效果更好。

Abstract:

[Objective] To evaluate the clinical outcomes of digital-assistance percutaneous vertebroplasty (PVP) for thoracolumbar os- teoporotic vertebral compression fractures (OVCF) . [Methods] From January 2019 to August 2020, 73 patients with single-segment OVCF were enrolled in this study and divided into two groups by random number method. Among them, 36 patients underwent 3D digital modeling and data measurement before surgery, and underwent digital-assistance (DA) unilateral PVP, while the other 37 patients received the tradi- tional PVP. Perioperative, follow-up and imaging data of the two groups were compared. [Results] All the patients in both groups had opera- tion completed successfully without serious complications. The DA group proved significantly superior to the traditional group in terms of operative time, puncture time and intraoperative fluoroscopy times (P<0.05) , despite of the fact that no significant differences were found in terms of the amount of bone cement injected, the incidence of bone cement leakage, time to resume walking and the full weight-bearing ac- tivity between the two groups (P<0.05) . As time went during follow up period lasted for (19.33±4.65) months, VAS and ODI scores de- creased significantly (P<0.05) , while JOA scores increased significantly in both groups (P<0.05) . At 3 days after operation, the DA group was superior to the traditional group in VAS, ODI and JOA scores (P<0.05) . Radiographically, the anterior vertebral height increased signif- icantly (P<0.05) , whereas the local Cobb angle decreased significantly in both groups postoperatively compared with those before operation (P<0.05) . However, there were no significant differences in aforesaid radiographic items between the two groups at any corresponding time points (P>0.05) . [Conclusion] Compared with traditional PVP, the digital-assistance PVP does improve the precision of thoracolumbar percutaneous pedicle puncture, reduce the number of X-ray fluoroscopy and operation time, and has better clinical results.