Liu Yiqiang, Wang Chengri, Wei Guoping, Huang Rui
Department of Spinal Surgery, the People's Hospital of Laibin, Laibin Guangxi, 546100,
Department of Spinal Surgery, the People's Hospital of Laibin, Laibin Guangxi, 546100, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 May 15;31(5):527-533. doi: 10.7507/1002-1892.201612104.
To evaluate the effect of remote controlled injection manipulator system (RCIM) assisted percutaneous kyphoplasty (PKP) for the treatment of rupture of posterior vertebral osteoporotic vertebral fracture by comparing with intermittent hand bolus injection of bone cement during operation.
Between September 2010 and January 2016, a retrospective analysis was made on the clinical data of 48 senile patients with single segment rupture of the posterior vertebral osteoporotic thoracolumbar fracture undergoing PKP who accorded with the inclusion criteria. Of 48 patients, 22 received intermittent hand bolus injection of bone cement in the control group, and 26 received RCIM assisted bone cement perfusion in the trial group. There was no significant difference in age, gender, duration of disease, causes of injury, implicated vertebral bodies, bone mineral density T value, pain duration, preoperative visual analogue scale (VAS), relative vertebral body height in the anterior part, and posterior convex Cobb angle between groups ( >0.05). The bone cement perfusion time, the radiation dose of both doctors and patients, and the amount of bone cement injection were recorded; treatment effects were evaluated based on VAS score, posterior convex Cobb angle, relative ver-tebral body height in the anterior part, ratios of bone cement diffusion area and bone cement leakage rate.
The patients were followed up for 6 months; no complications of toxic effect of bone cement, spinal cord or nerve root injuries, infection and vascular embolization occurred during follow-up period. There was no significant difference in bone cement injection amount and radiation dose of doctors between groups ( >0.05), but bone cement perfusion time, ratios of bone cement diffusion area, and radiation dose of patients were significantly lower in the trial group than the control group ( <0.05). Bone cement leakage was observed in 6 cases of the control group (27.27%) and 2 cases of the trial group (7.69%), showing significant difference between groups ( =4.850, =0.029); no cement leakage into the spinal canal was found in both groups. VAS score, relative vertebral body height in the anterior part, and posterior convex Cobb angle were significantly improved at 3 days and 6 months after operation when compared with preoperative ones ( <0.05), but no significant difference was observed in the above indexes between groups at 3 days and 6 months after operation ( >0.05).
Satisfactory effectiveness can be achieved by applying RCIM assisted PKP for the treatment of rupture of posterior vertebral osteoporotic vertebral fracture. RCIM can shorten perfusion time, reduce radiation dose, and decrease incidence of bone cement leakage.
通过与术中间歇性手动推注骨水泥相比较，评估遥控注射操纵器系统（RCIM）辅助经皮椎体后凸成形术（PKP）治疗骨质疏松性椎体骨折后柱破裂的效果。
回顾性分析2010年9月至2016年1月期间48例符合纳入标准的老年单节段骨质疏松性胸腰椎骨折后柱破裂行PKP治疗患者的临床资料。48例患者中，对照组22例采用间歇性手动推注骨水泥，试验组26例采用RCIM辅助骨水泥灌注。两组患者在年龄、性别、病程、受伤原因、受累椎体、骨密度T值、疼痛持续时间、术前视觉模拟评分（VAS）、椎体前部相对高度及后凸Cobb角方面比较，差异均无统计学意义（P>0.05）。记录骨水泥灌注时间、术者和患者的辐射剂量以及骨水泥注射量；根据VAS评分、后凸Cobb角、椎体前部相对高度、骨水泥弥散面积比及骨水泥渗漏率评估治疗效果。
患者随访6个月；随访期间未发生骨水泥毒性反应、脊髓或神经根损伤、感染及血管栓塞等并发症。两组骨水泥注射量及术者辐射剂量比较，差异无统计学意义（P>0.05），但试验组骨水泥灌注时间、骨水泥弥散面积比及患者辐射剂量均显著低于对照组（P<0.05）。对照组6例（27.27%）发生骨水泥渗漏，试验组2例（7.69%）发生骨水泥渗漏，两组比较差异有统计学意义（χ²=4.850，P=0.029）；两组均未发现骨水泥渗漏至椎管内。术后3天及6个月时，VAS评分、椎体前部相对高度及后凸Cobb角与术前比较均显著改善（P<0.05），但术后3天及6个月时上述指标组间比较差异无统计学意义（P>0.05）。
应用RCIM辅助PKP治疗骨质疏松性椎体骨折后柱破裂可取得满意疗效。RCIM可缩短灌注时间，降低辐射剂量，减少骨水泥渗漏发生率。
