| 骨水泥分布对单侧经椎弓根穿刺治疗脊柱骨质疏松骨折临床效果的影响 |
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Received:January 27, 2022
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| 作者 | Author | 单位 | Unit | E-Mail |
| 包利帅 |
BAO Li-shuai |
成都医学院第二附属医院 核工业四一六医院骨科, 四川 成都 610000 |
Department of Orthopaedics, the Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu 610000, Sichuan, China |
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| 吴伟 |
WU Wei |
成都医学院第二附属医院 核工业四一六医院骨科, 四川 成都 610000 |
Department of Orthopaedics, the Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu 610000, Sichuan, China |
404430566@qq.com |
| 钟喜红 |
ZHONG Xi-hong |
成都医学院第二附属医院 核工业四一六医院骨科, 四川 成都 610000 |
Department of Orthopaedics, the Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu 610000, Sichuan, China |
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| 曾文 |
ZENG Wen |
成都医学院第二附属医院 核工业四一六医院骨科, 四川 成都 610000 |
Department of Orthopaedics, the Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu 610000, Sichuan, China |
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| 严钰皓 |
YAN Yu-hao |
成都医学院第二附属医院 核工业四一六医院骨科, 四川 成都 610000 |
Department of Orthopaedics, the Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu 610000, Sichuan, China |
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| 王馨 |
WANG Xin |
成都大学附属医院科研科, 四川 成都 610000 |
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| 期刊信息：《中国骨伤》2022年35卷，第5期，第423-429页 |
| DOI：10.12200/j.issn.1003-0034.2022.05.004 |
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目的:探讨单侧穿刺行椎体成形术(percutaneous vertebroplasty,PVP)治疗脊柱骨质疏松骨折骨水泥不同形态分布对临床疗效的影响。
方法:回顾性选取2019年1月至2020年4月接受单侧穿刺PVP治疗的骨质疏松压缩性骨折患者66例(男16例,女50例),共83个椎体(胸椎45个,腰椎38个),其中单节段55例,双节段6例,3节段4例,4节段1例。纳入患者年龄60~93(76.83±8.65)岁,纳入患者发病后1~10 d就诊,术前均摄患椎正侧位X 线片、行 MRI 及骨密度仪检查明确诊断。按照术后X线中骨水泥的形态分为O形组(28例)和H形组(38例)。O形组骨水泥在术后X线患椎中呈聚集团块样分布;H形组骨水泥在术后X线患椎中呈弥散蜂窝状分布。收集两组患者骨水泥注射量;观察两组患者术中骨水泥渗漏及术后邻近椎体骨折的情况;比较两组患者术前及术后1 d、1个月、6个月、1年的视觉模拟评分(visual analogue scale,VAS)和术后1 d、6个月、1年的Oswestry功能障碍指数(Oswestry Disability Index,ODI);测量两组患者术前及术后1周、1年的患椎后凸角和患椎椎体前缘高度。
结果:66例患者均完成了1年以上的随访,术后穿刺处均愈合良好,O形组和H形组术中分别出现1例和8例骨水泥的渗漏(P<0.05),但均无严重的并发症发生;术后1年的随访中两组均出现1例邻椎骨折(P>0.05)。两组骨水泥注射量差异无统计学意义(P>0.05)。术前、术后1 d、术后6个月、术后1年VAS评分 O形组分别为7.89±0.79、2.75±1.08、0.46±0.58、0.36±0.49,H形组分别为8.00±1.04、2.58±1.15、0.53±0.56、0.42±0.50,组间比较差异均无统计学意义(P>0.05);而术后1个月O形组和H形组VAS评分分别为0.96±0.58和1.18±0.83,差异有统计学意义(P<0.05)。术后1 d、6个月、1年的ODI评分O形组分别为12.43±3.78、10.00±2.46、8.43±1.50,H形组分别为12.11±3.68、9.53±2.35、8.32±1.51,组间比较差异无统计学意义(P>0.05)。术前、术后1周、术后1年患椎后凸角和前缘高度两组间比较差异均无统计学意义(P>0.05)。
结论:无论骨水泥分分布形态是O形还是H形都能达到良好的临床效果,且预后效果相当。所以在进行单侧穿刺PVP手术时,不必为了达到患椎充分弥散的目的而刻意的增加穿刺针的穿刺角度,进而降低损伤重要结构、减少骨水泥渗漏等风险。 |
| [关键词]:骨质疏松 脊柱骨折 椎体成形术 骨水泥分布 |
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| Effect of bone cement distribution on the clinical outcome of unilateral transpedicular puncture for spinal osteoporotic fractures |
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Abstract:
Objective: To investigate the effects of different bone cement morphology distribution on the clinical efficacy of unilateral percutaneous vertebroplasty(PVP) for spinal osteoporotic fractures.
Methods: The clinical data of 66 patients with osteoporotic vertebral compression fractures received unilateral PVP treatment from January 2019 to April 2020 were retrospectively analyzed. There were 16 males and 50 females,including 83 vertebral bodies,45 thoracic vertebrae and 38 lumbar vertebrae,and 55 patients with single-segment,6 double-segment,4 three-segment and 1 four-segment. The age ranged from 60 to 93 years with an average of (76.83±8.65) years. The included patients were admitted to hospital 1 to 10 days after onset,and were diagnosed by anteroposterior and lateral X-rays,MRI and bone density examination before surgery. According to the shape of bone cement in postoperative X-ray,the patients were divided into O-shaped group (28 cases) and H-shaped group (38 cases). In O-shaped group,the bone cement presented agglomeration mass distribution in the affected vertebra in postoperative X-ray while the bone cement presented disseminated honeycomb distribution in the affected vertebrae in H-shaped group. Bone cement injection volume was collected in two groups. The intraoperative bone cement leakage and postoperative adjacent vertebral fractures were observed. The VAS of the two groups before operation and 1 day,1 month,6 months and 1 year after operation were compared;and ODI of the two groups 1 day,6 months and 1 year after operation were compared. The kyphosis angle and anterior height of the affected vertebrae were measured before operation and 1 week,1 year after operation.
Results: All 66 patients completed 1-year follow-up,and all patients healed well at the puncture site after surgery. There were 1 case and 8 cases of bone cement leakage in O-shaped group and H-shaped group during surgery respectively (P<0.05),but no serious complications occurred. One case occurred adjacent vertebral fracture in both groups during one-year follow-up (P>0.05). There was no statistical significance in injection amount of bone cement between the two groups (P>0.05). The VAS scores of O-shaped group and H-shaped group were 7.89±0.79,2.75±1.08,0.46±0.58,0.36±0.49 and 8.00±1.04,2.58±1.15,0.53±0.56,0.42±0.50 before operation,1 day,6 months,1 year after operation respectively,and there was no statistical significance(P>0.05),and the VAS scores were 0.96±0.58 and 1.18±0.83 at 1 month after operation respectively,with statistical significance(P<0.05). The ODI scores of O-shaped group and H-shaped group were 12.43±3.78,10.00±2.46,8.43±1.50 and 12.11±3.68,9.53±2.35,8.32±1.51 at 1 day,6 months and 1 year after surgery respectively,and there was no statistical significance between the two groups(P>0.05). There were no statistical significance in kyphotic angles and anterior height before surgery and 1 week,1 year after surgery between two groups (P>0.05).
Conclusion: No matter the distribution of bone cement is O-shape or H-shape,it can achieve good clinical effect,and the prognosis effect is equivalent. Therefore,when performing unilateral puncture PVP surgery,it is not necessary to deliberately increase the puncture angle of the puncture needle in order to achieve the full diffusion of the affected vertebrae,so as to reduce the risk of damaging important structures and bone cement leakage. |
| KEYWORDS:Osteoporosis Spinal fractures Vertebroplasty Bone cement distribution |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 包利帅,吴伟,钟喜红,曾文,严钰皓,王馨.骨水泥分布对单侧经椎弓根穿刺治疗脊柱骨质疏松骨折临床效果的影响[J].中国骨伤,2022,35(5):423~429 |
| 英文格式: | BAO Li-shuai,WU Wei,ZHONG Xi-hong,ZENG Wen,YAN Yu-hao,WANG Xin.Effect of bone cement distribution on the clinical outcome of unilateral transpedicular puncture for spinal osteoporotic fractures[J].zhongguo gu shang / China J Orthop Trauma ,2022,35(5):423~429 |
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