目的 探讨设计的操作路径方案在经皮椎体后凸成形术(PKP)中预防骨水泥渗漏的作用.方法 对不同时间段收治的292例患者(392椎),分别采用未实施操作路径(实施前组183椎),实施操作路径(实施后组209椎),统计分析两组治疗中出现的骨水泥渗漏变化,并同时对患者术前、术后疼痛进行VAS评价.结果 实施前组29椎出现骨水泥渗漏(15.85%),实施后组12椎出现骨水泥渗漏(5.74%),两者比较差异有统计学意义(P<0.01).VAS平均值:术前1 d为7.56分±0.65分,术后3 d为2.12分±0.95分,术后3个月为2.69分±1.16分,与术前1 d比较差异有统计学意义(P<0.05),术后3 d与术后3个月比较差异无统计学意义(P>0.05).结论 操作路径方案起到加强医疗管理、规范治疗行为、减少医源性失误作用,能有效降低和预防PKP治疗中骨水泥渗漏的发生.%Objective To study the role of operating routes in preventing bone cement leakage in percutaneous ky-phoplasty. Methods 292 patients ( 392 vertebrae ) were divided into non-receiving operating routes ( before the implementation group of 183 vertebrae ), and received operating routes ( after the implementation group of 209 of vertebrae ). Through collecting and analyzing, the bone cement leakage in two group was observed. VAS were used before and after operation. Results Before operating routes were adopted, bone cement leakage occurred in 29 vertebrae ( 15. 85% ); after operating routes were adopted,bone cement leakage occurred in 12 vertebrae( 5. 74% ). It was of great statistical significance ( P < 0. 01 ). A day before the operation, the average of VAS was ( 7. 56 ± 0. 65 ) points. Three days after the operation, the average of VAS was ( 2. 12 ± 0. 95 ) points. Three months after the operation, the average of VAS was ( 2. 96 ± 1. 16 ) points. Also, it was of great statistical significant to compare with a day before the operation( P < 0. 05 ), it was not statisitcal significant to compare with three days and three months after the operation( P >0. 05 ). Conclusions With operating routes, enhanced medical management, standard treatment conduction , and reduction of iatrogenic errors, the occurrence of bone cement leakage in PKP treatment may be effectively reduced and prevented.
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