| 体位复位靶点穿刺技术在老年脊柱骨质疏松性骨折经皮椎体成形术中的应用比较 |
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投稿时间：2024-07-03
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| 作者 | Author | 单位 | Address | E-Mail |
| 吴浙 |
WU Zhe |
浙江中医药大学第三临床医学院, 浙江 杭州 310005 |
The Third Clinical Medical School Affilicated to Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang, China |
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| 陈建良 |
CHEN Jian-liang |
绍兴市上虞区中医医院骨伤科, 浙江 绍兴 312300 |
Shangyu Hospital of Traditional Chinese Medicine of Shaoxing City, Shaoxing 312300, Zhejiang, China |
chjil8168@163.com |
| 李英周 |
LI Ying-zhou |
绍兴市上虞区中医医院骨伤科, 浙江 绍兴 312300 |
Shangyu Hospital of Traditional Chinese Medicine of Shaoxing City, Shaoxing 312300, Zhejiang, China |
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| 许勇 |
XU Yong |
绍兴市上虞区中医医院骨伤科, 浙江 绍兴 312300 |
Shangyu Hospital of Traditional Chinese Medicine of Shaoxing City, Shaoxing 312300, Zhejiang, China |
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| 期刊信息：《中国骨伤》2025年，第38卷，第2期，第119-127页 |
| DOI：10.12200/j.issn.1003-0034.20231045 |
| 基金项目:浙江省中医药科学研究基金项目(编号:2021ZB311) |
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中文摘要:
目的: 比较常规经皮椎体成形术(percutaneous vertebroplasty,PVP)与体位复位和靶点穿刺技术治疗老年脊柱骨质疏松性骨折的骨水泥弥散情况以及临床疗效。
方法: 回顾性分析2021年1月至2023年3月268例老年性单椎体脊柱骨折患者临床资料,根据治疗方法分为常规PVP组和靶点PVP组。常规双侧入路PVP组(常规组)138例,男26例,女112例;年龄(72.9±4.0)岁;采用双侧入路传统PVP治疗。靶点PVP组130例,男23例,女107例;年龄(72.2±7.0)岁;采用俯卧牵引按压整复法先整复骨折,再用手术床使脊柱过伸维持椎体复位和骨折间隙靶点穿刺推注骨水泥。根据影像检查评价骨水泥是否在骨折间隙内充分填充。比较两组手术时间、骨水泥渗漏率及渗漏类型、骨水泥在骨折区域填充情况、骨水泥注入量、胸腰背疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)及骨折椎体局部后凸Cobb角。
结果: 常规组的手术时间(43.9±5.7) min、骨水泥充填量(5.3±1.5) ml,高于靶点组(39.3±3.6) min、(4.1±1.7) ml,差异有统计学意义(P<0.05)。两组骨水泥渗漏率、渗漏类型比较差异均无统计学意义(P>0.05)。靶点PVP组骨折区域均得到充足骨水泥填充,常规PVP组34例出现骨水泥在骨折区域填充不充分,两组比较差异有统计学意义(P<0.01)。两组术前胸腰背疼痛VAS、ODI及骨折椎体局部后凸Cobb角比较,差异均无统计学意义(P>0.05)。术后3 d靶点组的VAS(3.64±0.94)分、ODI(11.50±0.38)分,优于常规组(4.69±0.78)分、(15.06±1.66)分,差异有统计学意义(P<0.05)。末次随访靶点组局部Cobb角(7.51±5.37)°,小于传统组(11.68±3.98)°,差异有统计学意义(P<0.05)。
结论: 体位复位技术和靶点穿刺在老年脊柱骨质疏松性骨折经皮椎体成形技术中应用,有以下优点:利用体位复位技术恢复椎体高度,避免椎间软组织张力过高;骨折间隙靶点穿刺技术有效固定椎体骨折,骨水泥有效充盈,提高手术疗效,是一种安全、有效的新技术。 |
| 【关键词】经皮椎体成形术 骨水泥弥散 老年人 骨质疏松 椎体压缩性骨折 骨折间隙 |
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| Clinical research of traditional bone-setting and target puncture techniques in percutaneous vertebroplasty for osteoporotic vertebral compression fractures |
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ABSTRACT
Objective To compare the bone cement diffusion and clinical effects between conventional percutaneous vertebroplasty(PVP) and the application of positioning reduction and targeted puncture techniques in the treatment of elderly patients with osteoporotic vertebral compression fractures.
Methods A retrospective comparative study was conducted,analyzing the clinical data of 268 elderly patients with single-level vertebral fractures admitted between January 2021 and March 2023. The patients were divided into two groups:the conventional PVP group (138 cases) and the targeted PVP group (130 cases). Among them,138 patients in the conventional group were treated by traditional PVP with bilateral approach including 26 males and 112 females,with a mean age of (72.9±4.0) years old. Another 130 patients in the targeted PVP group included 23 males and 107 females,with a mean age of (72.2±7.0) years old;vertebral reduction was first achieved using prone traction and compression reduction technique based on preoperative imaging examination,the operating bed was used to maintain spinal hyper-extension of the spine and puncture the fracture space target to inject bone cement. The adequacy of bone cement filling in the fracture gap was evaluated based on imaging examination. The operation time,the rate of bone cement leakage and the type of leakage,bone cement filling in the fracture area,the amount of cement injection,the thoracolumbar back pain visual analogue scale(VAS),Oswestry disability index(ODI),and the local kyphosis Cobb angle of the fractured vertebra were compared between two groups.
Results The operation time (43.9±5.7) min,bone cement filling (5.3±1.5) ml in the conventional PVP group were higher than the target group (39.3±3.6) min,(4.1±1.7) ml(P<0.05). There were no statistically significant differences in bone cement leakage rate or type(P>0.05). The targeted PVP group achieved sufficient bone cement filling in the fracture area,while the conventional PVP group had 34 cases (25.0%) with insufficient filling in the fracture area(P<0.01). There was no significant difference in VAS,ODI,and local Cobb angle of the fractured vertebra before operation between two groups(P>0.05). The VAS of 3.64±0.94 and ODI of 11.50±0.38 at 3 day after operation in the target group were better than those of the conventional group 4.69±0.78 and 15.06±1.66 (P<0.05). The local Cobb angle (7.51±5.37)° was less than that of the conventional group (11.68±3.98)°(P<0.05).
Conclusion The application of positioning reduction and targeted puncture techniques in percutaneous vertebroplasty for elderly patients with osteoporotic vertebral compression fractures can restore vertebral height using positioning reduction technique to avoid excessive tension on the intervertebral soft tissue. Targeted puncture technique effectively stabilizes vertebral fractures and achieves adequate bone cement filling,thereby improving surgical outcomes. This technique is safe and effective,representing a new treatment modality. |
| KEY WORDS Percutaneous vertebroplasty(PVP) Bone cement diffusion Aged Osteoporosis Vertebral compression fractures Fracture gap |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 吴浙,陈建良,李英周,许勇.体位复位靶点穿刺技术在老年脊柱骨质疏松性骨折经皮椎体成形术中的应用比较[J].中国骨伤,2025,38(2):119~127 |
| 英文格式: | WU Zhe,CHEN Jian-liang,LI Ying-zhou,XU Yong.Clinical research of traditional bone-setting and target puncture techniques in percutaneous vertebroplasty for osteoporotic vertebral compression fractures[J].zhongguo gu shang / China J Orthop Trauma ,2025,38(2):119~127 |
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