He Yi, Bai Yi-Guang
Department of Orthopaedics, Nanbu County People's Hospital, Nanbu 637300, Sichuan, China.
Department of Orthopaedics, Nanchong Central Hospital, Nanshong 637000, Sichuan, China.
Zhongguo Gu Shang. 2023 Jan 25;36(1):86-91. doi: 10.12200/j.issn.1003-0034.2023.01.016.
To study the application of different puncture techniques to inject bone cement in osteoporotic vertebral compression fractures (OVCFs).
The clinical data of 282 patients with OVCFs treated from January 2017 to December 2019 were collected for a retrospective study. According to the surgical plan the patients were divided into group A and B, with 141 cases in each group. In group A, extreme lateral puncture was used to inject bone cement through unilateral puncture and bilateral puncture. In group B, bone cement was injected through unilateral pedicle puncture through pedicle approach. The operation status(operation time, radiation exposure time, bone cement injection volume, hospital stay) and complications were observed between two groups. Before operation and 6, 12 months after operation, the pain mediators such as serotonin 5-hydroxytryptamine (5-HT), prostaglandin E2(PGE2), substance P(SP) were compared, bone mineral density, anatomical parameters of the injured vertebrae (height of the anterior edge of the vertebral body, height of the posterior edge of the vertebral body, Cobb angle), visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated between two groups.
There were no significant difference in operation time, radiation exposure time, hospital stay between two groups (>0.05). The amount of bone cement injected in group A was greater than that in group B (<0.05). The serum 5-HT, SP and PGE2 levels of group A were lower than those of group B at 12 months after operation (<0.05). The height of anterior edge and height of the posterior edge of vertebral body in group A were greater than those of group B at 12 months after operation, Cobb angle of group A was smaller than that of group B, VAS and ODI were lower than those of group B(<0.05). There was no significant difference in bone mineral density between two groups at 6 and 12 months postoperatively(<0.05). There was no significant difference between two groups in postoperative complications (>0.05).
Compared with unilateral puncture of the pedicle approach, unilateral puncture and bilateral cement injection technique is more conducive to the recovery of the injured vertebral anatomy and function, and do not prolong operation time, radiation exposure time, hospital stay, nor do increase the risk of nerve damage and bone cement leakage, and postoperative bone metabolism and bone mineral density are improved well, which is a safe and reliable surgical method for the treatment of OVCFs.
研究不同穿刺技术在骨质疏松性椎体压缩骨折（OVCFs）中注入骨水泥的应用。
收集2017年1月至2019年12月治疗的282例OVCFs患者的临床资料进行回顾性研究。根据手术方案将患者分为A组和B组，每组141例。A组采用极外侧穿刺，通过单侧穿刺和双侧穿刺注入骨水泥。B组采用经椎弓根入路单侧椎弓根穿刺注入骨水泥。观察两组的手术情况（手术时间、辐射暴露时间、骨水泥注入量、住院时间）及并发症。在术前及术后6、12个月，比较两组的疼痛介质如5-羟色胺（5-HT）、前列腺素E2（PGE2）、P物质（SP），评估骨密度、受伤椎体的解剖参数（椎体前缘高度、椎体后缘高度、Cobb角）、视觉模拟评分（VAS）和Oswestry功能障碍指数（ODI）。
两组手术时间、辐射暴露时间、住院时间比较差异无统计学意义（>0.05）。A组骨水泥注入量大于B组（<0.05）。术后12个月A组血清5-HT、SP和PGE2水平低于B组（<0.05）。术后12个月A组椎体前缘高度和椎体后缘高度大于B组，A组Cobb角小于B组，VAS和ODI低于B组（<0.05）。术后6、12个月两组骨密度比较差异无统计学意义（<0.05）。两组术后并发症比较差异无统计学意义（>0.05）。
与经椎弓根入路单侧穿刺相比，单侧穿刺双侧注入骨水泥技术更有利于受伤椎体解剖结构和功能的恢复，不延长手术时间、辐射暴露时间和住院时间，也不增加神经损伤和骨水泥渗漏风险，且术后骨代谢和骨密度改善良好，是治疗OVCFs安全可靠的手术方法。
