Jia Bao-Xin, Ju Jing, Liu Cheng-Zhou, Gao Xiao-Qiang, Wang Ting
Linqu County People's Hospital, Weifang 262600, Shandong, China.
Weifang People's Hospital, Weifang 261044, Shandong, China.
Zhongguo Gu Shang. 2025 Jul 25;38(7):729-36. doi: 10.12200/j.issn.1003-0034.20230662.
To investigate the clinical efficacy of bilateral targeted puncture in percutaneous vertebroplasty(PVP) based on the vertebral osteodense zone.
A retrospective analysis was conducted on 76 patients with fresh symptomatic osteoporotic vertebral compression fractures, characterized by the presence of a dense zone, who underwent percutaneous vertebroplasty (PVP) between January 2021 and December 2021. All patients involved single-level vertebral fractures. There were 19 males and 57 females, aged from 62 to 88 years old, with an average of (68.5±12.5) years old. All patients underwent bilateral transpedicular puncture procedures. Preoperative CT or MRI was utilized to ascertain the relative position of the bone osteodense zone within the vertebral body (specifically, whether this zone is situated in the upper one-third or one-quarter of the left or right sagittal plane). Considering the head and tail regions of the dense zone as puncture targets, the puncture points and paths were meticulously planned, and the working channel was subsequently established. Under continuous monitoring by a C-arm X-ray machine, bone cement was carefully and gradually injected. The operation time, bone cement injection volume, and bone cement leakage were recorded. The visual analogue scale (VAS) and Oswestry disablity index (ODI) were used to evaluate the effectiveness of the operation. ODI and anterior height (AH) of the vertebral body were used to evaluate the efficacy.
All patients successfully completed the surgery and were followed up for (8.0±1.0) months. The operation time was (36.57±11.25) min, the volume of bone cement injection was(6.07±1.19) ml, and 21 patients of bone cement leakage. There were 3 patients with the VAS exceeded 4 points two days postoperatively, indicating suboptimal pain management. At the three time points of pre-operation, 2 days post-operation and 6 months post-operation, the VAS scores were(7.82±1.29), (2.11±0.44), and (2.04±0.67) respectively;the ODI percentages were(75.65±7.23)%, (29.45±4.16)%, and(28.68±5.62)%;and the AH values were (11.02±1.30), (12.87±3.91), and (12.91±3.86) cm. The differences were all statistically significant(<0.05). The aforementioned three indices demonstrated significant improvement at both 2 days and 6 months post-operation (all <0.05). There were no statistically significant differences in these indices between the 2-day and 6-month post-operative periods(>0.05). The postoperative outcome was satisfactory and durable, with no evidence of vertebral height reduction.
Bilateral targeted puncture based on the osteodense dense zone within the vertebral body can achieve bilateral symmetrical and upright full vertebral bone cement reinforcement without increasing bone cement leakage, achieving good early efficacy and preventing late vertebral collapse. This has positive significance for further improving the efficacy of percutaneous vertebroplasty.
探讨基于椎体骨密度致密区的双侧靶向穿刺在经皮椎体成形术（PVP）中的临床疗效。
回顾性分析2021年1月至2021年12月期间76例有症状的新鲜骨质疏松性椎体压缩骨折且存在致密区的患者，所有患者均接受经皮椎体成形术（PVP）。所有患者均为单节段椎体骨折，其中男性19例，女性57例，年龄62～88岁，平均（68.5±12.5）岁。所有患者均接受双侧椎弓根穿刺操作。术前利用CT或MRI确定椎体骨密度致密区在椎体内的相对位置（具体而言，该区域是否位于左或右矢状面的上三分之一或四分之一处）。将致密区的头端和尾端作为穿刺靶点，精心规划穿刺点和路径，随后建立工作通道。在C型臂X线机持续监测下，小心、逐步注入骨水泥。记录手术时间、骨水泥注入量及骨水泥渗漏情况。采用视觉模拟评分法（VAS）和Oswestry功能障碍指数（ODI）评估手术效果，用ODI和椎体前缘高度（AH）评估疗效。
所有患者均成功完成手术，随访（8.0±1.0）个月。手术时间为（36.57±11.25）分钟，骨水泥注入量为（6.07±1.19）毫升，21例发生骨水泥渗漏。术后2天有3例患者VAS评分超过4分，提示疼痛控制欠佳。术前、术后2天和术后6个月三个时间点的VAS评分分别为（7.82±1.29）、（2.11±0.44）和（2.04±0.67）；ODI百分比分别为（75.65±7.23）%、（29.45±4.16）%和（28.68±5.62）%；AH值分别为（11.02±1.30）、（12.87±3.91）和（12.91±3.86）厘米。差异均有统计学意义（<0.05）。上述三项指标在术后2天和6个月时均有显著改善（均<0.05）。术后2天和6个月时这些指标之间无统计学差异（>0.05）。术后效果满意且持久，无椎体高度降低的迹象。
基于椎体内骨密度致密区的双侧靶向穿刺可实现双侧对称且垂直的全椎体骨水泥强化，而不增加骨水泥渗漏，取得良好的早期疗效并预防后期椎体塌陷。这对进一步提高经皮椎体成形术的疗效具有积极意义。
