单侧经椎弓根入路穿刺行PVP和PKP治疗上中胸椎骨质疏松性椎体压缩性骨折疗效观察
摘要
目的探讨单侧经椎弓根入路穿刺行经皮椎体成形术(PVP)和经皮椎体后凸成形术(PKP)治疗上中胸椎骨质疏松性椎体压缩性骨折(OVCF)的技术要点与疗效。方法采用单侧经椎弓根入路穿刺行PVP或PKP治疗上中胸椎OVCF患者24例36个椎体,其中8例10个椎体行PVP,18例26个椎体行PKP。比较术前、术后1d及末次随访时视觉模拟评分法(VAS)评分及伤椎椎体前缘、中间高度恢复值,CT复查骨水泥弥散情况,计算骨水泥渗漏率。结果 24例患者36个椎体均完成PVP和PKP治疗,手术时间为25～35min/椎。所有患者骨水泥在椎体内均左右对称分布,其中骨水泥渗漏3例,渗漏率为12.50%。2例患者穿刺部位出现局限性血肿,术后3～5d血肿吸收;1例患者穿刺侧肋间神经分布区疼痛,3～5d疼痛消失;无血气胸、脊髓损伤及肺栓塞等严重并发症发生。与术前比较,术后1d、末次随访时VAS评分均降低,椎体前缘高度恢复值及中间高度恢复值均升高,差异均有统计学意义(均P<0.05)。所有患者均随访12～24(16±4)个月,椎体形态未见改变。CT复查骨水泥弥散良好,均过椎体中线。结论单侧经椎弓根入路穿刺行PVP或PKP治疗上中胸椎OVCF是一种安全、可行和有效的治疗方法,C型臂X线机透视可精准监测经椎弓根入路治疗,骨水泥注射时机和注射量是治疗成功的关键。
引文
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[17]刘小勇,杨慧林,唐天驷,等.椎体后凸成形术棘突定位穿刺点与穿刺轨道的研究[J].中华骨科杂志,2007,27(3):197-201.DOI:10.3760/j.issn:0253-2352.2005.08.004.
[2]李永甫,贺振年,郭剑,等.全身营养状况对经皮椎体后凸成型术后椎体再骨折发生的影响[J].浙江医学,2017,39(7):521-524.DOI:10.12056/j.issn.1006-2785.2017.39.7.2017-242.
[3]王振斌,涂来勇,顾文飞,等.PKP与PVP治疗轻中度骨质疏松性椎体压缩性骨折的临床疗效比较[J].浙江医学,2016,38(23):1896-1898.
[4]Zhou T,Lin H,Wang H,et al.Comparative study on the biomechanics between improved PVP and traditional PKP in the treatment of vertebral peripheral wall damage-type OVCF[J].Exp Ther Med,2017,14(1):575-580.DOI:10.3892/etm.2017.4542.
[5]Niu J,Song D,Zhou H,et al.Percutaneous Kyphoplasty for the Treatment of Osteoporotic Vertebral Fractures With Intravertebral Fluid or Air:A Comparative Study[J].Clin Spine Surg,2017,30(8):367-373.DOI:10.1097/BSD.0000000000000262.
[6]Yang S,Chen C,Wang H,et al.A systematic review of unilateral versus bilateral percutaneous vertebroplasty/percutaneous kyphoplasty for osteoporotic vertebral compression fractures[J].Acta Orthop Traumatol Turc,2017,51(4):290-297.DOI:10.1016/j.aott.2017.05.006.
[7]Kwan MK,Chiu CK,Chan CY,et al.A comparison of feasibility and safety of percutaneous fluoroscopic guided thoracic pedicle screws between Europeans and Asians:is there any difference?[J].Eur Spine J,2016,25(6):1745-1753.DOI:10.1007/s00586-015-4150-4.
[8]Ploss C,Maier B,Mack MG,et al.Accuracy of CT-assisted pedicle screw placement after CT-controlled,presurgical guide wire implantation in traumatic and pathological fractures in the thoracic spine[J].Eur J Trauma Emerg Surg,2011,37(2):121-126.DOI:10.1007/s00068-010-0069-y.
[9]饶书城,宋跃明.脊柱外科手术学[M].北京:人民卫生出版社,2007:319-320.
[10]徐卫星,陈其昕,李方才,等.C臂X线透视下分步引导上中胸椎椎弓根螺钉安全植入实验研究[J].中国脊柱脊髓杂志,2007,29(7):1054-1056.DOI:10.3969/j.issn.1004-406X.2008.02.015.
[11]Liebschner MA,Rosenberg WS,Keaveny TM.Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty[J].Spine(Phila Pa 1976),2001,26(14):1547-1554.DOI:10.1097/00007632-200107150-00009.
[12]陈柏龄,谢登辉,黎艺强,等.单侧PKP骨水泥注射过中线分布对压缩性骨折椎体两侧刚度的影响[J].中国脊柱脊髓杂志,2011,21(2):118-121.DOI:10.3969/j.issn.1004-406X.2011.02.07.
[13]陈书连,卢义峰,王振,等.探讨椎弓根外穿刺行单侧PVP或PKP术治疗上中位胸椎骨质疏松性压缩骨折[J].中国脊柱脊髓杂志,2011,21(11):905-909.DOI:10.3969/j.issn.1004-406X.2011.11.06.
[14]Boszczyk BM,Bieschneider M,Hauck S,et al.Transcostovertebral kyphoplsty of the mid and hight thoracic spine[J].Eur Spine J,2006,15(1):8-15.DOI:10.1007/s00586-005-0943-1.
[15]Han KR,Kim C,Eun JS,et al.Extrapedicular approach of percutaneous vertebroplasty in the treatment of upper and mid-thoracic vertebral compression fracture[J].Acta Radiol,2005,46(3):280-287.DOI:10.1080/02841850510021058.
[16]Vialle R,Zeller R,Gaines RW.The"slide technique":an improvement on the"funnel technique"for safe pedicle screw placement in the thoracic spine[J].Eur Spine J,2014,23(Suppl4):S452-456.DOI:10.1007/s00586-014-3342-7.
[17]刘小勇,杨慧林,唐天驷,等.椎体后凸成形术棘突定位穿刺点与穿刺轨道的研究[J].中华骨科杂志,2007,27(3):197-201.DOI:10.3760/j.issn:0253-2352.2005.08.004.
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