Tan Bing, Fan Bin, Yang Qi-Yuan, Feng Jing, Lei Chao, Feng Wei, Luo Xiao, Li Ying-Bo
Department of Spinal Surgery, the Third People's Hospital of Mianyang City, Sichuan Mental Health Center, Mianyang 621000, Sichuan, China.
Zhongguo Gu Shang. 2021 Aug 25;34(8):710-6. doi: 10.12200/j.issn.1003-0034.2021.08.005.
To explore the methods and efficacy of unilateral extra-pedicle precision puncture percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty(PKP) by digital subtraction angiography (DSA) for the treatment of osteoporotic vertebral compression fractures (OVCFs).
The clinical data of 68 patients with osteoporotic vertebral compression fractures treated from August 2015 to December 2018 were retrospectively analyzed. There were 20 males and 48 females, aged 56 to 90(73.5±8.0) years, 40 cases of double segments, 28 cases of three segments, a total of 168 vertebrae. All the patients were performed PVP orPKP through unilateral extra pedicle precision puncture under the guidance of DSA. The vertebrae were distributed in T-T(29 vertebrae), T-T(89 vertebrae), and L-L(50 vertebrae). Whether the puncture needle tip reached the midline of vertebral body was observed during operation, the leakage rate of bone cement was recorded after operation. The height of anterior edge and middle of the fractured vertebral body were measured after operation. Visual analogue scale (VAS) and the Oswestry Disability Index (ODI) were used to assess pain and lumbar function before operation, 3 days after operation and final follow-up time.
All the punctures were successful in 68 patients. All the puncture needles reached the midline of vertebral body, and the bone cement was well dispersed in the vertebral body with symmetrical distribution. The operation time was 35 to 60 (41.6±3.2) minutes, and there was no puncture complications. The injection volume of bone cement was 3 to 5 (3.6±0.5) ml in each vertebra. There were 8 cases of bone cement leakage, with a leakage rate of 11.76%. All 68 patients were followed up from 12 to 27 (14.3±3.5) months in the study. VAS score and ODI at 3 days after surgery and at final follow-up time were significantly improved (<0.05). The height of the anterior edge and the middle of vertebral body at 3 days after operation and at final were significantly recovered (<0.05).
PVP or PKP under the guidance of DSA via a unilateral extrapedicular approach with precision puncture can effectively relieve pain, restore vertebral body height and spinal function, which is a safe, fast and effective method in the treatment of osteoporotic vertebral compression fractures.
探讨数字减影血管造影（DSA）引导下经单侧椎弓根外精准穿刺经皮椎体成形术（PVP）或经皮椎体后凸成形术（PKP）治疗骨质疏松性椎体压缩骨折（OVCFs）的方法及疗效。
回顾性分析2015年8月至2018年12月收治的68例骨质疏松性椎体压缩骨折患者的临床资料。其中男20例，女48例，年龄56～90（73.5±8.0）岁，双节段40例，三节段28例，共168个椎体。所有患者均在DSA引导下经单侧椎弓根外精准穿刺行PVP或PKP。椎体分布于胸10～胸12（29个椎体）、胸12～腰2（89个椎体）、腰1～腰3（50个椎体）。术中观察穿刺针尖端是否到达椎体中线，术后记录骨水泥渗漏率。术后测量骨折椎体前缘及椎体中部高度。采用视觉模拟评分法（VAS）和Oswestry功能障碍指数（ODI）评估术前、术后3天及末次随访时的疼痛及腰椎功能。
68例患者穿刺均成功。所有穿刺针均到达椎体中线，骨水泥在椎体内弥散良好，分布对称。手术时间35～60（41.6±3.2）分钟，无穿刺并发症。每个椎体骨水泥注射量3～5（3.6±0.5）ml。骨水泥渗漏8例，渗漏率为11.76%。本研究68例患者均获随访，随访时间12～27（14.3±3.5）个月。术后3天及末次随访时VAS评分及ODI均较术前显著改善（<0.05）。术后3天及末次随访时椎体前缘及椎体中部高度均较术前显著恢复（<0.05）。
DSA引导下经单侧椎弓根外精准穿刺行PVP或PKP能有效缓解疼痛，恢复椎体高度及脊柱功能，是治疗骨质疏松性椎体压缩骨折安全、快速、有效的方法。
