三种穿刺经皮椎体成形术的比较

Comparison of three puncture techniques used for percutaneous vertebroplasty

摘要:

[目的] 比较三种穿刺椎体成形术 （percutaneous vertebroplasty, PVP） 治疗骨质疏松性压缩骨折 （osteoporotic com- pression fracture, OVCF） 的临床与影像结果。[方法] 选择 2019 年 3 月—2020 年 3 月本科收治的 83 例骨质疏松性椎体压缩骨折患者，随机分为 3 组，单侧组 27 例，双侧组 28 例和弯角 （percutaneous curved vertebroplasty, PCVP） 组 28 例，分别行相应穿刺 PVP 术。比较三组患者围手术期、随访及影像结果。[结果]所有患者均顺利完成手术，无严重并发症。双侧组的手术时间和住院费用均显著高于单侧组和弯角组（P＜0.05）。弯角组骨水泥注入量显著大于单侧组和双侧组 [(4.1±0.6 ) ml vs (3.4±0.3) ml vs (3.5±0.3) ml, P=0.029]，而弯角组骨水泥渗漏率显著低于单侧组和双侧组 [0.0% vs 22.2% vs10.7%, P=0.029]。所有患者随访（13.7± 1.2）个月，随时间推移，三组 VAS、ODI 评分均显著降低（P＜0.05）。术前三组间 VAS、ODI 评分的差异均无统计学意义（P＞ 0.05），但末次随访时，双侧组和弯角组 ODI 评分显著优于单侧组 [(23.7±3.8) vs (23.7±3.6) vs (26.0±3.6), P=0.029]。影像方面，双侧组、弯角组的伤椎骨水泥弥散分布优秀率显著高于单侧组 [85.7% vs 82.1% vs 59.3%, P=0.045]。与术前相比，术后 1 个月及末次随访时三组患者椎体前缘高度显著增加（P＜0.05），而 Cobb 角显著降低（P＜0.05）。末次随访时，弯角组椎体前缘高度、Cobb 角丢失比例小于双侧组与单侧组，但差异并无统计学意义（P＞0.05）。[结论] CVP 能够增加骨水泥推注的准确性，降低骨水泥渗漏风险，改善 OVCF 患者远期功能。

关键词:骨质疏松性骨折;经皮椎体成形术;穿刺方法;骨水泥;疗效

Abstract:

[Objective] To compare the clinical and imaging consequences of three puncture techniques used in percutaneous vertebro- plasty (PVP) for osteoporotic compression fracture (OVCF). [Methods] A total of 83 patients with OVCF admitted to our department from March 2019 to March 2020 were enrolled into this study and randomly divided into 3 groups. Of them, 27 patients received unilateral PVP (the uPVP group), 28 cases underwent bilateral PVP (the bPVP group) and 28 cases had percutaneous curved vertebroplasty performed (the PCVP group). The documents regarding to perioperative period follow-up and radiographs were compared among the three groups. [Results] All patients were successfully operated on without serious complications. The bPVP group consumed significantly longer operation time, with more times of fluoroscopy and greater hospitalization cost than the uPVP and PCVP groups (P＜0.05). The PCVP group had significantly more bone cement injected [(4.1±0.6 ) ml vs (3.4±0.3) ml vs (3.5±0.3) ml, P=0.029], whereas significantly lower incidence of cement leakage [0.0% vs 22.2% vs 10.7%, P=0.029] than the uPVP and bPVP groups. As time went during the follow-up lasted for (13.7±1.2) months, the VAS and ODI scores significantly decreased in all the three groups (P＜0.05). Although there were no statistically significant differences in VAS and ODI scores among the three groups before surgery (P＞0.05), the PCVP and bPVP groups proved significantly superior to the uPVP group in ODI score [(23.7±3.8) vs (23.7±3.6) vs (26.0±3.6), P=0.029] at the latest follow-up (P＜0.05). Radiographically, PCVP and bPVP groups proved significantly superior to the uPVP group in term of excellent rate of bone cement distribution in vertebral body [85.7% vs 82.1% vs 59.3%, P=0.045]. Compared with those preoperatively, the anterior vertebral height was significantly increased (P＜0.05), while Cobb angle was significantly decreased in all the three groups postoperatively (P＜0.05). At the latest follow-up, the PCVP group had less loss in term of anterior vertebral height and correction of local kyphosis in term of Cobb's angle than the bPVP and uPVP groups, despite of no statistically significant differences among them (P＞0.05). [Conclusion] The PCVP does highlight accuracy of cement injection, reduce the risk of cement leakage, and improve long-term function of OVCF patients.

Key words:osteoporotic fracture; percutaneous vertebroplasty; puncture method; bone cement; efficacy