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目的探讨改良推管用于单侧椎弓根穿刺经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)的可行性及疗效。方法2012年1月—2016年1月,将收治并符合选择标准的60例(68个椎体)骨质疏松椎体压缩性骨折(osteoporotic vertebral compression fractures,OVCF)患者随机分为两组:常规组30例(34个椎体)及改良组30例(34个椎体),分别采用常规推管及改良推管行单侧椎弓根穿刺PKP。两组患者性别、年龄、病程、骨折节段及术前疼痛视觉模拟评分(VAS)、椎间高度等一般资料比较,差异均无统计学意义(P>0.05)。记录并比较两组手术时间、骨水泥注入量,术前及术后2 d、末次随访VAS评分,术前及术后2 d、1年椎体高度,术后2 d骨水泥弥散系数。结果术后两组患者穿刺点均愈合良好,均无严重并发症发生。两组手术时间以及骨水泥注入量比较,差异均无统计学意义(t=0.851,P=0.399;t=1.672,P=0.101)。两组各2例术中发生骨水泥渗漏。常规组骨水泥弥散系数低于改良组(t=13.049,P=0.000)。患者均获随访,随访时间12~36个月,平均19个月。两组术后两时间点VAS评分、椎体高度与术前比较,差异均有统计学意义(P<0.05);组内术后两时间点间比较,差异无统计学意义(P>0.05)。两组间术后两时间点以上指标比较,差异均无统计学意义(P>0.05)。X线片复查示,常规组6例、改良组1例患者随访期间发生其他节段椎体压缩性骨折。结论单侧椎弓根穿刺PKP术中,采用改良推管注射骨水泥可以改善骨水泥在椎体内的弥散,恢复椎体高度,有效加强椎体内稳定,减少再骨折发生,疗效满意。
Objective To investigate the feasibility and efficacy of modified catheterization for percutaneous kyphoplasty (PKP). Methods From January 2012 to January 2016, 60 patients (68 vertebral bodies) with osteoporotic vertebral compression fractures (OVCF) who were admitted to our hospital and met the selection criteria were randomly divided into two groups: conventional 30 patients (34 vertebrae) and 30 patients (34 vertebrae) in the modified group were treated with unilateral pedicular puncture (PKP) by conventional catheterization and modified catheterization. There was no significant difference between the two groups in general information such as gender, age, course of disease, fracture segment, preoperative visual analogue scale (VAS) and intervertebral height (P> 0.05). The operation time, the amount of cement injection, the preoperative and postoperative 2 d, the VAS score at the last follow-up, the vertebral body height at 2 d and 1 year after operation and the cement diffusion coefficient at 2 d after operation were recorded and compared. Results After operation, the puncture points of both groups healed well without any serious complication. There was no significant difference between the two groups in the operation time and the amount of cement injection (t = 0.851, P = 0.399; t = 1.672, P = 0.101). Two cases occurred in each case of bone cement leakage. The diffusion coefficient of bone cement in the conventional group was lower than that in the modified group (t = 13.049, P = 0.000). Patients were followed up for 12 to 36 months, an average of 19 months. The VAS scores and vertebral body height at two time points after operation were significantly different from those before operation (P <0.05). There was no significant difference between the two groups in postoperative time points (P> 0.05) . There was no significant difference in the above two indexes between the two groups (P> 0.05). X-ray examination showed that 6 patients in the conventional group and 1 patient in the modified group had other segmental vertebral compression fractures during follow-up. Conclusions During unilateral pedicle puncture PKP, using improved prostatic injection of cement can improve the dispersion of cement in the vertebral body, restore vertebral height, effectively stabilize the vertebral body and reduce the occurrence of re-fractures, and the curative effect is satisfactory.