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椎弓根体外复位器在经皮椎体后凸成形术中的临床应用

Clinical application of the pedicle in vitro restorer in percutaneous kyphoplasty.

作者信息

Qi Yimin, Zeng Yiwen, Wang Dalin, Sui Jisheng, Wang Qiang

机构信息

Nanjing Medical University, Nanjing, China.

Department of Orthopaedic Surgery, Nanjing First Hospital, Nanjing Medical University, #68 Changle Rd, Qinhuai District, Nanjing, 210000, Jiangsu, China.

出版信息

J Orthop Surg Res. 2018 Oct 25;13(1):268. doi: 10.1186/s13018-018-0978-8.

Abstract

BACKGROUND

Percutaneous kyphoplasty (PKP) is widely applied for the treatment of osteoporotic vertebral compression fractures (OVCFs) and has achieved satisfactory clinical results. With the accumulation of clinical cases and prolonged follow-up times, the inability to reconstruct vertebral height defects has attracted more and more attention. A comparison of clinical effects was retrospectively reviewed in 72 patients who underwent simple PKP or pedicle in vitro restorer (PIVR) combined with PKP to discuss the clinical application of self-developed PIVR used in PKP.

METHODS

From August 2013 to August 2016, 72 patients with OVCFs were treated surgically, with 30 patients undergoing PKP (group A) and 42 undergoing PIVR combined with PKP (group B). Operation-related situations, radiological data, and related scores were compared between the two groups by corresponding statistical methods.

RESULTS

Bone cement was successfully injected into 72 vertebral bodies. Sixty-three cases were followed up for an average of 14 months. There were significant differences between the two groups in the improvement of the height of the vertebral body, sagittal Cobb angle, and visual analogue scale (VAS) 1 week after the operation (P < 0.05), and the improvements of group B were better than those in group A. The cement leakage ratio was significantly different between the two groups (P < 0.05). The Oswestry Disability Index (ODI) at last follow-up was significantly different between the two groups (P < 0.05). There was no significant difference in the incidence of recurrent vertebral fractures between the two groups at the last follow-up (P > 0.05).

CONCLUSION

PIVR combined with PKP can overcome the limitations of PKP alone, that is, hardly restoring vertebral height and height being easily lost again with balloon removal. The combined method can also restore the vertebral fractures to a satisfactory height and effectively maintain the stability of the spine, which improves the long-term quality of life of patients. Thus, PIVR combined with PKP is a better choice for patients with OVCFs.

摘要

背景

经皮椎体后凸成形术(PKP)广泛应用于骨质疏松性椎体压缩骨折(OVCFs)的治疗,并取得了满意的临床效果。随着临床病例的积累和随访时间的延长,椎体高度缺损无法重建的问题越来越受到关注。回顾性分析72例行单纯PKP或椎弓根体外复位器(PIVR)联合PKP治疗患者的临床疗效,探讨自行研制的PIVR在PKP中的临床应用。

方法

2013年8月至2016年8月,对72例OVCFs患者进行手术治疗,其中30例行PKP(A组),42例行PIVR联合PKP(B组)。采用相应的统计方法比较两组的手术相关情况、影像学资料及相关评分。

结果

72个椎体均成功注入骨水泥。63例患者平均随访14个月。两组术后1周椎体高度、矢状面Cobb角及视觉模拟评分(VAS)改善情况比较差异有统计学意义(P<0.05),B组改善情况优于A组。两组骨水泥渗漏率比较差异有统计学意义(P<0.05)。末次随访时两组Oswestry功能障碍指数(ODI)比较差异有统计学意义(P<0.05)。末次随访时两组椎体再骨折发生率比较差异无统计学意义(P>0.05)。

结论

PIVR联合PKP可克服单纯PKP的局限性,即难以恢复椎体高度且球囊取出后高度易再次丢失。联合方法还可将椎体骨折恢复至满意高度并有效维持脊柱稳定性,从而提高患者的长期生活质量。因此,PIVR联合PKP是OVCFs患者的较好选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9e06/6203289/545bb813a301/13018_2018_978_Fig1_HTML.jpg

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