Cui Zhi-Dong, Yang Guang, Zhang Da-Peng
The First Department of Orthopaedics, Puyang Oilfield General Hospital, Puyang 457000, Henan, China.
Zhongguo Gu Shang. 2021 Aug 25;34(8):725-31. doi: 10.12200/j.issn.1003-0034.2021.08.007.
Taking the classic bilateral puncture vertebroplasty as a reference, to evaluate the clinical efficacy of vertebroplasty of the curved-angle puncture device, analyze the radiation exposure of patients and surgeons during the operation and summarize the protective measures.
The clinical data of 49 patients with osteoporotic vertebral compression fractures admitted from March 2018 to September 2019 were retrospectively analyzed. According to the different surgical puncture methods, 49 patients were divided into vertebroplasty group (using classic bilateral puncture) and curved vertebroplasty group (using curved angle puncture). Among them, there were 26 cases in vertebroplasty group, including 7 males and 19 females, aged (73.25±6.36) years, 2 cases in thoracic segment, 21 cases in thoracolumbar segment, and 3 cases in lumbar segment. In curved vertebroplasty group, there were 23 cases, including 6 males and 17 females, aged (73.09±6.52) years, 3 cases in thoracic segment, 19 cases in thoracolumbar segment, and 1 case in lumbar segment. The operation time and the amount of injected bone cement in the two groups were recorded. Visual analogue scale (VAS) and modified Oswestry Disability Index (ODI) were respectively used to assess the pain degree and lumbar function, the postoperative bone cement leakage or other complications were observed. The radiation doses of the two groups of patients and surgeons were compared.
All 49 patients were followed up for 10-22 (14.55±3.83) months. Eleven cases in vertebroplasty group and 9 cases in curved vertebroplasty group occurred bone cement leakage after surgery, and there was no statistically significant difference between two groups. VAS scores of vertebroplasty group were 6.23±0.68 before operation and 1.69±0.47 at 1 day after operation, respectively, modified ODI were (72.59±3.25)% and (33.59±2.85)%. The preoperative and postoperative VAS scores of curved vertebroplasty group were 6.46±0.56 and 1.57±0.49, respectively, modified ODI were (73.21±3.18)% and (33.17±2.37)%. The postoperative pain degree and lumbar function of the two groups were significantly improved, but the difference between the groups was not statistically significant. The operation time of curved vertebroplasty group and vertebroplasty group were (17.27±9.58) min and(23.19±8.56) min, and the amount of injected bone cement were (4.91±1.49) ml and (6.58±1.42) ml. Obviously, curved vertebroplasty group has more advantages in operation time and the amount of injected bone cement. In curved vertebroplasty group, the radiation dose of the operator was (0.53±0.05) mSv and the patient was (10.64±1.65) mSv;in vertebroplasty group, the operator was (0.59±0.08) mSv andthe patient was (13.52±1.81) mSv. The radiation dose of patients in curved vertebroplasty group was significantly lower than that of the vertebroplasty group, but there was no statistically significant difference in the operator between two groups.
Both puncture methods can achieve satisfactory clinical results, but curved angle puncture can optimize the distribution of bone cement and reduce the radiation dose of patients.
以经典双侧穿刺椎体成形术为参照，评估弯角穿刺器械椎体成形术的临床疗效，分析手术中患者及术者的辐射暴露情况并总结防护措施。
回顾性分析2018年3月至2019年9月收治的49例骨质疏松性椎体压缩骨折患者的临床资料。根据手术穿刺方法不同，将49例患者分为椎体成形术组（采用经典双侧穿刺）和弯角椎体成形术组（采用弯角穿刺）。其中，椎体成形术组26例，男7例，女19例，年龄（73.25±6.36）岁，胸椎段2例，胸腰段21例，腰椎段3例。弯角椎体成形术组23例，男6例，女17例，年龄（73.09±6.52）岁，胸椎段3例，胸腰段19例，腰椎段1例。记录两组手术时间及骨水泥注入量。分别采用视觉模拟评分法（VAS）和改良Oswestry功能障碍指数（ODI）评估疼痛程度及腰椎功能，观察术后骨水泥渗漏等并发症情况。比较两组患者及术者的辐射剂量。
49例患者均获随访10 - 22（14.55±3.83）个月。椎体成形术组术后骨水泥渗漏11例，弯角椎体成形术组9例，两组比较差异无统计学意义。椎体成形术组术前VAS评分为6.23±0.68，术后1天为1.69±0.47，改良ODI分别为（72.59±3.25）%和（33.59±2.85）%。弯角椎体成形术组术前、术后VAS评分分别为6.46±0.56和1.57±0.49，改良ODI分别为（73.21±3.18）%和（33.17±2.37）%。两组术后疼痛程度及腰椎功能均明显改善，但组间差异无统计学意义。弯角椎体成形术组与椎体
成形术组手术时间分别为（1727±9.58）分钟和（23.19±8.56）分钟，骨水泥注入量分别为（4.91±1.49）毫升和（6.58±1.42）毫升。显然，弯角椎体成形术组在手术时间及骨水泥注入量方面更具优势。弯角椎体成形术组术者辐射剂量为（0.53±0.05）毫希伏，患者为（10.64±1.65）毫希伏；椎体成形术组术者为（0.59±0.08）毫希伏，患者为（13.52±1.81）毫希伏。弯角椎体成形术组患者辐射剂量明显低于椎体成形术组，但两组术者辐射剂量比较差异无统计学意义。
两种穿刺方法均能取得满意的临床效果，但弯角穿刺可优化骨水泥分布并降低患者辐射剂量。
