弯角椎体成形术治疗胸腰椎骨质疏松性椎体压缩骨折的疗效分析

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目的 :评估分析弯角椎体成形术(percutaneous curved vertebroplasty,PCVP)治疗胸腰椎骨质疏松性椎体压缩骨折的临床疗效。方法:选取96例胸腰椎骨质疏松性椎体压缩骨折患者,共128节病椎,将其分为弯角组(36例,43节)、单侧组(32例,42节)及双侧组(28例,43节),分别行PCVP及单侧、双侧椎弓根入路椎体成形术。3组患者的性别、年龄、骨密度及病椎节段分布均无统计学差异(P>0.05)。统计3组手术时间、X线曝光次数、骨水泥注入量及术前、术后24h、术后3个月疼痛视觉模拟评分(VAS评分),术后复查CT评价骨水泥渗漏率,进行统计学分析。结果:弯角组与单侧组的手术时间、X线曝光次数均明显少于双侧组,差异有统计学意义(P<0.05),弯角组和单侧组无显著性差异(P>0.05)。弯角组、单侧组、双侧组的骨水泥注入量比较,双侧组最多(6.2±1.5ml),弯角组次之(4.5±1.3ml),单侧组最少(3.4±1.2ml),组间两两比较差异有统计学意义(P<0.05)。弯角组、单侧组、双侧组的骨水泥渗漏率比较,单侧组(28.6%,12/42)最高,双侧组(18.6%,8/43)次之,弯角组(9.3%,4/43)最低,组间两两比较差异有统计学意义(P<0.05)。3组患者术后疼痛均明显缓解,术后24h及术后3个月VAS评分均明显低于术前(P<0.05),术后24h及术后3个月VAS评分比较无显著性差异(P>0.05),同时间点组间比较亦无显著性差异(P>0.05)。结论:PCVP具有操作简单、手术时间短、X线透视次数少、创伤小、并发症少等优势,是治疗胸腰椎骨质疏松性椎体压缩骨折的有效微创手术方法。 Objective: To evaluate the clinical efficacy of percutaneous curved vertebroplasty (PCVP) in the treatment of thoracolumbar osteoporotic vertebral compression fractures. Methods: A total of 128 patients with vertebral compression fractures of thoracolumbar vertebrae were enrolled and divided into three groups (36 cases, 43 cases), unilateral group (32 cases, 42 cases) and double Group (28 cases, 43 cases), respectively, and PCVP and unilateral and bilateral pedicle approach vertebroplasty. There were no significant differences in sex, age, bone mineral density and the distribution of diseased vertebrae between the three groups (P> 0.05). The operation time, the number of X-ray exposures, the amount of bone cement injected, and the pain visual analogue scale (VAS score) at 3 months before operation and after operation, and postoperative 3 months postoperatively were evaluated. Analysis. Results: The operation time and the number of X-ray exposure in the bending angle group and the unilateral group were significantly less than those in the bilateral group (P <0.05), but there was no significant difference between the bending angle group and the unilateral group (P> 0.05). The amount of bone cement injection in the bending group, unilateral group and bilateral group was the highest (6.2 ± 1.5ml) in the bilateral group, followed by the bending angle group (4.5 ± 1.3ml) and the lowest in the unilateral group (3.4 ± 1.2ml ), The difference between groups was statistically significant (P <0.05). The rate of bone cement leakage in flexion group, unilateral group and bilateral group was the highest in unilateral group (28.6%, 12/42), followed by bilateral group (18.6%, 8/43) 9.3%, 4/43), the difference between the two groups was statistically significant (P <0.05). The postoperative pain relief was significantly relieved in all 3 groups. The VAS scores at 24 and 3 months after operation were significantly lower than those before operation (P <0.05), and there was no significant difference in VAS scores at 24 and 3 months P> 0.05). There was no significant difference between the two groups at the same time point (P> 0.05). Conclusions: PCVP has the advantages of simple operation, short operative time, less fluoroscopy, less trauma and less complications. It is an effective minimally invasive surgical method for the treatment of osteoporotic vertebral compression fractures in thoracolumbar spine.
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