侧开口骨水泥推注器结合分阶段注射技术治疗老年胸腰段骨质疏松性压缩骨折疗效分析

Clinical efficacy of side opening bone cement push injector combined with staged injection in the treatment of osteoporotic compression fracture of thoracolumbar vertebral body in elderly patients

关键词:  骨质疏松性椎体压缩骨折  经皮椎体强化术  经皮椎体后凸成形术  骨水泥渗漏  侧开口骨水泥推注器  分阶段注射

Key words:  osteoporotic vertebral compression fractures  percutaneous vertebroplasty  percutaneous kyphoplasty  bone cement leakage  side opening bone cement push injector  staged injection

摘要:

目的　探讨侧开口骨水泥推注器结合分阶段注射技术在经皮椎体后凸成形术（percutaneous kyphoplasty，PKP）中预防骨水泥渗漏的临床疗效。方法　回顾性分析2007年1月至2017年1月150例单节段老年胸腰段骨质疏松压缩性骨折患者的临床资料，行双侧穿刺PKP治疗，采用侧开口骨水泥推注器结合分阶段注射技术76例（分阶段组），传统注射技术74例（对照组），比较患者术前及术后1天、3个月、6个月VAS评分、椎体后凸角（Cobb角）改善情况、Oswestry功能障碍指数（Oswestry disability index，ODI）、骨水泥渗漏情况以评估手术疗效。结果　150例患者行双侧椎弓根穿刺术，成功率100%。与术前相比，分阶段组和对照组术后1天、3个月和6个月的VAS评分、椎体后凸Cobb角和ODI值差异均有统计学意义（P均<0.05），但组间无差异。骨水泥渗漏情况：分阶段组7例，对照组20例，差异具有统计学意义（P<0.05），但均无临床症状。 结论　侧开口骨水泥推注器结合分阶段注射技术能明显降低经皮椎体强化术中的骨水泥渗漏率，迅速缓解疼痛，改善生活质量，临床效果满意。

Abstract:

Objective To investigate the clinical efficacy of side opening bone cement push injector combined with staged injection of percutaneous kyphoplasty (PKP) in preventing bone cement leakage. Methods A retrospective analysis from January 2007 to January 2017 in our hospital was performed. Totally 150 cases of single segment senile osteoporotic compression fractures of thoracolumbar spine were treated with PKP. Among them, 76 cases (stage group) were treated with side opening bone cement injection combined with staged injection; and 74 cases (control group) were treated with traditional injection technique. The differences of age, gender, bone mineral density, preoperative pain visual analogue scale (VAS), and fracture compression degree were not statistically significant between the two groups. VAS score, Cobb angle, Oswestry disability index(ODI), and bone cement leakage were compared between groups before surgery, and 1 days, 3 months and 6 months after surgery. Results Bilateral pedicle puncture was performed in 150 patients with a success rate of 100%. The postoperative VAS scores, Cobb angles of vertebral kyphosis, and ODI scores were significantly different from the preoperative values (P<0.05). There were 7 cases of bone cement leakage in stage group and 20 cases of bone cement leakage in control group. The difference between the two groups were statistically significant (P<0.05). However, there were no clinical symptoms in both groups. Conclusion The side opening bone cement push injector combined with staged injection can obviously reduce the leakage rate of bone cement during the percutaneous vertebroplasty, quickly relieve pain, improve the quality of life, and have good clinical effect.