应用弯角椎体成形装置修复胸腰段骨质疏松性椎体压缩骨折

发布时间：2019-01-21 21:04

【摘要】：背景:国内目前在椎体增强技术(椎体成形及椎体后凸成形)中所使用的骨填充物输送管道其头端是平直、无法弯曲的。修复过程中,一般会选择在椎体内部采用对称地注入骨填充物的方式来保持椎体生物力学上的受力平衡,而传统的骨填充物输送管只能用于同侧椎体骨填充。目的:探讨应用弯角椎体成形装置修复胸腰段骨质疏松性椎体压缩骨折的可行性。方法:纳入60例骨质疏松性压缩骨折患者,共72个椎体,其中8例为双节段,2例为3节段椎体骨折。全部应用弯角输送通道行经皮椎体成形术,记录手术时间、术中出血量、影像学资料,进行前瞻性自身对照,采用改良Oswestry功能障碍指数、目测类比评分和简易生活质量测定量表(WHOQOL-BREF)评价骨折修复效果,随访6个月-2年。结果与结论:160例患者骨折修复手术均顺利完成,50例单椎体手术时间为20-45 min,平均27 min;272个椎体中单个椎体骨水泥注入量为4.2-9.5 m L,平均6.4 m L。骨水泥分布未出现偏向单侧分布情况,未出现相关严重渗漏并发症;3治疗后1 d患者目测类比评分及ODI均较治疗前显著改善(P0.05);末次随访时与治疗后1 d相比,差异无显著性意义(P0.05);4治疗前生活质量良好患者比例占27%,治疗后1个月和末次随访时增至87%和92%,差异有显著性意义(P0.05);5结果提示,应用弯角椎体成形装置行单侧椎弓根穿刺,可确保椎体骨水泥双侧对称分布,修复效果满意,是一种可行、简单、安全的新方法。
[Abstract]:Background: bone fillers used in vertebrae enhancement (vertebroplasty and kyphoplasty) are straight and unbending. In the process of restoration, we usually choose to use symmetrical bone filling to maintain the balance of the biomechanics of the vertebral body, but the traditional bone filling pipe can only be used for the ipsilateral vertebra bone filling. Objective: to investigate the feasibility of the application of bending vertebroplasty in the repair of osteoporotic vertebral compression fracture in thoracolumbar segment. Methods: a total of 72 vertebrae were included in 60 patients with osteoporotic compression fractures, of which 8 were double-segmented and 2 were 3-level vertebral fractures. All patients underwent percutaneous vertebroplasty with angle conveyer channel. The time of operation, intraoperative blood loss and imaging data were recorded, and prospective self-control was performed. The modified Oswestry dysfunction index was used. Visual analogue score and simple quality of Life scale (WHOQOL-BREF) were used to evaluate the effect of fracture repair. Results and conclusion: the fracture repair was successfully completed in 160 patients. The average time of single vertebral body operation was 20 to 45 min, 27 min; in 272 vertebrae, and the average injection amount of single vertebral cement was 4.2-9.5 mL, with an average of 6.4 mL. The distribution of bone cement was not biased to one side and there was no serious leakage complication. 3 the visual analogue score and ODI were significantly improved 1 day after treatment (P0.05). There was no significant difference between the last follow-up and 1 day after treatment (P0.05). (4) the proportion of patients with good quality of life before treatment was 27%, which increased to 87% and 922% after one month and the last follow-up (P0.05). The results suggest that the unilateral pedicle puncture with angle forming device can ensure the symmetrical distribution of bone cement in both sides of the vertebral body, and the repair effect is satisfactory. It is a feasible, simple and safe new method.
【作者单位】：解放军总医院骨科;
【基金】：国家自然科学基金资助项目(51372276)~~
【分类号】：R687.3;R580

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