目的 探讨双向激光定位G形臂透视单侧注射骨水泥在老年性骨质疏松伴病理性骨折治疗中的应用效果。方法 回顾性分析解放军总医院第三医学中心2021-02至2023-02治疗的118例高龄骨质疏松伴病理性骨折患者的临床资料。依据不同的成像技术分为两组,对照组63例,运用C形臂X线机辅助实施经皮椎体成形术(PVP)和经皮椎体后凸成形术(PKP)手术;观察组55例,采用装备有双向激光导航的G形臂X线机辅助手术。比较两组在围手术期的临床指标、手术前后的视觉模拟评分(VAS)、脊椎前缘压缩比例以及Cobb角度后凸变化,并记录手术后水泥渗漏的情况和邻近椎体骨折的再次发生率。结果 在手术用时、手术中X线透视的时长、聚甲基丙烯酸甲脂(PMMA)骨水泥注入量、X线透视次数及搅拌至注射的时间等多个方面,观察组与对照组差异有统计学意义(P＜0.05)。手术方式与时间交互作用及手术方法与时长对VAS评分有影响,且差异有统计学意义(P＜0.05)。术后第3天时点处,研究组VAS评分低于对照组,差异有统计学意义(P＜0.05)。手术类型和时间对患者椎体前端压缩与后突的Cobb角比较,差异无统计学意义;但就主要效应而论,这些参数的差异有统计学意义(P＜0.05)。在术后3 d与一年的比较中,观察组在椎体前端高度的压缩度和后凸的Cobb角的减少优于对照组,差异有统计学意义(P＜0.05)。观察组术后骨水泥渗漏率3.64%,低于对照组的15.87%,差异有统计学意义(P＜0.05)。两组术后3个月、12个月邻近椎体再发骨折发生率差异无统计学意义。结论 双向激光定位透视单侧注射骨水泥是一种安全有效的治疗方法,能够减轻疼痛、恢复椎体形态和稳定性,降低骨水泥渗漏风险,在老年性骨质疏松伴病理性骨折的临床应用中具有潜在的临床推广价值。
Abstract
Objective To investigate the effect of bidirectional laser positioning fluoroscopy by G-arm X-ray with unilateral injection of bone cement in senile osteoporosis with pathologic fractures. Methods The clinical records of 118 elderly patients with osteoporotic vertebral compression fractures concurrent with pathological breaks treated by the Third Medical Center of PLA General Hospital between February 2021 and February 2023 were retrospectively analyzed. These patients were divided into two groups according to different imaging techniques. The control group (n=63) received percutaneous vertebroplasty (PVP) or balloon kyphoplasty (PKP) with the assistance of a C-arm fluoroscopy device, and the experimental group (n=55) received PVP or PKB under the guidance of a G-arm fluoroscope. An evaluative comparison of the pre-operative and post-operative Visual Analog Scale (VAS) scores, the degree of vertebral body compression anteriorly, and the kyphotic deformation measured by the Cobb angle was carried out between the two groups, and the postoperative cement leakage and recurrence of adjacent vertebral fractures were recorded. Results There were significant differences between the two group in the time of operation, the duration of X-ray fluoroscopy, the injection amount of PMMA bone cement, the times of X-ray fluoroscopy and the time from stirring to injection (P<0.05). The interaction between operation mode and time and operation method and duration had significant effects on VAS scores, with statistical difference (P<0.05). The VAS score of the experimental group was lower than that of the control group at the time point of the 3rd day after surgery, and the difference was statistically significant (P<0.05). There was no significant difference in Cobb Angle between anterior compression and posterior process between the patients with the type and time of operation. However, in terms of the main effects, the differences in these parameters were statistically significant (P<0.05). Assessments conducted at three-day intervals and again one year after the operation revealed substantial changes in the anterior height of the vertebrae and adjustments to the Cobb angle. The experimental group displayed a significantly decreased angle of kyphosis in relation to the control group (P<0.05). The postoperative bone cement leakage rate in the experimental group was 3.64%, lower than that in the control group (15.87%), and the difference was statistically significant (P<0.05). There was no significant difference in the recurrence rate of adjacent vertebral fractures 3 months and 12 months after surgery between the two groups. Conclusions Unilateral injection of bone cement by bidirectional laser positioning fluoroscopy is a safe and effective treatment method, which can relieve pain, restore vertebral shape and stability, and reduce the risk of bone cement leakage, and has potential clinical promotion value in the clinical application of senile osteoporosis with pathological fractures.
关键词
双向激光定位透视 /
单侧注射骨水泥 /
老年性骨质疏松 /
病理性骨折
Key words
bidirectional laser positioning fluoroscopy /
unilateral injection of bone cement /
senile osteoporosis /
pathological fracture
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基金
国家自然科学基金面上项目(81873914),首都临床特色应用研究(Z181100001718018),首都卫生发展科研重点专项项目(2018-1-5021)
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