L5骨质疏松性骨折单侧入路经皮椎体成形

Unilateral percutaneous vertebroplasty for lumbar 5 osteoporotic vertebral compression fracture

摘要:

[目的]探讨单侧入路经皮椎体成形术(percutaneous vertebroplasty, PVP)治疗 L₅骨质疏松性骨折(osteoporotic verte- bral compression fracture, OVCF)的临床结果。[方法]2018 年 11 月—2022 年 7 月采用经 L₄椎弓根体表投影外缘约 2 cm 处为入针点、L₅椎弓根体表投影外上缘为椎弓根穿刺点的单侧入路 PVP 治疗 L₅-OVCF 47 例患者，评价临床与影像资料。[结果] 47 例均顺利完成手术，手术时间 14~50 min，骨水泥注入量 3.5~10 ml；发生骨水泥渗漏 11 例，但均无神经损伤并发症。随访 2~ 26 个月，随时间推移 (术前，出院时，末次随访时)，患者的 VAS [(7.1±1.0), (1.7±0.8), (0.9±0.6), P＜0.001] 及 ODI 评分 [(67.6± 16.6), (16.9±8.6), (10.2±4.7), P＜0.001] 均显著减少。末次随访时，按改良 MacNab 标准，临床结果评定为优 19 例，良 22 例，可 6 例，优良率为 87.2%。影像方面，术后复查 X 线片显示骨水泥分布均过椎体中线。与术前相比，术后椎体前缘高度显著增加 [(2.1±0.4)cm, (2. 7±0.3)cm, P＜0.001]。[结论]此种技术 PVP 治疗 L₅-OVCF 近期临床效果满意。

Abstract:

[Objective] To investigate the clinical results of unilateral percutaneous vertebroplasty (PVP) in the treatment of L₅ osteopo- rotic compression fracture (OVCF). [Methods] From November 2018 to July 2022, 47 patients with L₅-OVCF were treated with unilateral PVP with puncture skin entry point about 2cm away the outer edge of the L₄ pedicle projection, while bone entry point at the outer upper edge of the L₅ pedicle. The clinical and imaging data were evaluated. [Results] All the 47 patients were successfully operated on with the operation time of 14~50 min, the injection volume of bone cement of 3.5~10 ml. Bone cement leakage occurred in 11 cases, whereas which not led any complications, such as nerve injury. With time of follow-up lasted for 2 to 26 months (before surgery, at discharge and at last fol- low-up), the VAS score [(7.1±1.0), (1.7±0.8), (0.9±0.6), P＜0.001] and ODI scores [(67.6±16.6), (16.9±8.6), (10.2±4.7), P＜0.001] signifi- cantly reduced. At the last follow-up, the clinical results were marked as excellent in 19 cases, good in 22 cases, fair in 6 cases, with the ex- cellent and good rate of 87.23% based on the modified MacNab criteria. Radiographically, postoperative radiographs showed that bone ce- ment was distributed across the midline of the vertebral body in all of them. Compared with that preoperatively, the anterior height of verte- bral body significantly increased postoperatively [(2.1±0.4)cm, (2.7 ±0.3)cm, P＜0.001]. [Conclusion] This technique of PVP does achieve satisfactory clinical outcomes in short term for L₅-OVCF.