改良骨水泥推注套筒在经皮椎体成形术中的应用

摘要

目的 比较改良骨水泥推注套筒(前端封闭,单侧开口)与传统直推骨水泥套筒在经皮穿刺椎体成形术(PVP)中的临床应用.方法 自2015年1月至2016年6月选取78例有PVP指征的单节骨质疏松压缩性骨折(OVCF),随机分为观察组与对照组(各39例),两组均在DSA透视下实施PVP.对比两组术中X线暴露剂量、手术时间、骨水泥渗漏情况、VAS评分(术前、术后3d、术后6个月)、术后半年内再骨折率及术后骨水泥分布情况.结果 两组均获得随访6～ 12月,骨水泥渗漏情况:观察组椎旁5例,对照组椎旁9例,椎前1例.两组均未发生神经及血管损伤,无肺栓塞等严重并发症.两组患者随访半年均未发生再骨折.两组放射剂量及手术时间相比有统计学意义(P＜0.05);两组骨水泥注入量及术前术后VAS评分相比无明显差异(P＞0.05),两组骨水泥分布比较无明显差异(P＞0.05),观察组骨水泥渗漏率低于对照组,有统计学意义(P＜0.05).结论 改良骨水泥推注套筒的使用可缩短手术时间,减少术中X线暴露及降低骨水泥渗漏率,临床效果无差异.%Objective To comparemodified bone cement injection sleeve (front end closed,unilateral opening) and traditional straight push bone cement sleeve in percutaneous vertebral plasty (PVP) for clinical application.Methods From January 2015 to June 2016,78 patients with PVP indications of single osteoporotic vertebral compression fracture (OVCF) were randomly divided into a study group and a control group (39 patients for each group),and both groups received PVP under DSA.Intraoperative X-ray exposure dose,surgical duration,postoperative bone cement leakage,VAS score (preoperative and postoperative 3 days and 6 months),and refracture rate after half a year and postoperative bone cement distribution were compared between the two groups.Results Both groups received a follow-up for 6 to 12 months.5 patients had paravertebralleakage in the study group,while 9 patients developed paravertebralleakage and orie patient had anterior leakage in the control group.No neurologic and vascular injury occurred,no pulmonary embolism and other serious complications developed.The patients in both groups were followed up for half a year without re-fracture.The radiation dose and surgical duration in the two groups were statistically significant (P＜0.05).Bone cement injection and postoperative VAS scoresdid not differ obviously between the two groups (P＞0.05),There was no significant difference between the two groups in distribution of bone cement (P＞0.05).The bone cement leakage rate was lower in the study group than in the control group,with a statistical significance (P＜0.05).Conclusions The improvement in bone cement injection sleeve can shorten surgical duration,reduce intraoperative X-ray exposure,and decrease the rate of leakage of bone cement.It is worth popularizing clinically.