中国修复重建外科杂志

中国修复重建外科杂志

远程遥控骨水泥推注系统辅助经皮椎体后凸成形术治疗后壁破裂型骨质疏松性椎体骨折

查看全文

目的 通过与术中间断手推注骨水泥进行比较,评估远程遥控骨水泥推注系统(remote controlled injection manipulator system,RCIM)辅助经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗后壁破裂型骨质疏松性椎体骨折的效果。 方法 回顾分析 2010 年 9 月—2016 年 1 月收治并符合选择标准的 48 例行 PKP 治疗的单节段后壁破裂型骨质疏松性胸腰椎骨折老年患者临床资料,根据术中骨水泥推注方式分为 2 组:对照组 22 例采用手推杆间断推注骨水泥,试验组 26 例采用 RCIM 辅助推注骨水泥。两组患者性别、年龄、病程、致伤原因、累及椎体、骨密度 T 值、疼痛持续时间及术前疼痛视觉模拟评分(VAS)、伤椎前缘相对高度、伤椎后凸 Cobb 角等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。记录两组术中骨水泥灌注期时间、医患双方接受辐射剂量、骨水泥注入量;采用 VAS 评分、伤椎后凸 Cobb 角、伤椎前缘相对高度、骨水泥弥散面积比值、骨水泥渗漏率评价疗效。 结果 两组患者均获随访,随访时间 6 个月。术后均无骨水泥毒性反应,无脊髓、神经损伤,无感染、血管栓塞等并发症发生。两组骨水泥注入量及术者接受辐射剂量比较差异无统计学意义(P>0.05),但试验组骨水泥灌注期时间、骨水泥弥散面积比值及患者接受辐射剂量显著少于对照组(P<0.05)。对照组和试验组分别有 6 例(27.27%)和 2 例(7.69%)出现骨水泥渗漏,比较差异有统计学意义(χ2=4.850,P=0.029);两组均无经后壁向椎管内渗漏。两组术后 3 d 及 6 个月 VAS 评分、伤椎前缘相对高度和伤椎后凸 Cobb 角均较术前显著改善(P<0.05);两组间以上指标比较差异均无统计学意义(P>0.05)。 结论 RCIM 辅助 PKP 治疗后壁破裂型骨质疏松性椎体骨折可获得满意临床效果,缩短了灌注期时间,可有效减少患者接受辐射剂量,降低骨水泥渗漏发生率。

Objective To evaluate the effect of remote controlled injection manipulator system (RCIM) assisted percutaneous kyphoplasty (PKP) for the treatment of rupture of posterior vertebral osteoporotic vertebral fracture by comparing with intermittent hand bolus injection of bone cement during operation. Methods Between September 2010 and January 2016, a retrospective analysis was made on the clinical data of 48 senile patients with single segment rupture of the posterior vertebral osteoporotic thoracolumbar fracture undergoing PKP who accorded with the inclusion criteria. Of 48 patients, 22 received intermittent hand bolus injection of bone cement in the control group, and 26 received RCIM assisted bone cement perfusion in the trial group. There was no significant difference in age, gender, duration of disease, causes of injury, implicated vertebral bodies, bone mineral density T value, pain duration, preoperative visual analogue scale (VAS), relative vertebral body height in the anterior part, and posterior convex Cobb angle between groups (P>0.05). The bone cement perfusion time, the radiation dose of both doctors and patients, and the amount of bone cement injection were recorded; treatment effects were evaluated based on VAS score, posterior convex Cobb angle, relative ver-tebral body height in the anterior part, ratios of bone cement diffusion area and bone cement leakage rate. Results The patients were followed up for 6 months; no complications of toxic effect of bone cement, spinal cord or nerve root injuries, infection and vascular embolization occurred during follow-up period. There was no significant difference in bone cement injection amount and radiation dose of doctors between groups (P>0.05), but bone cement perfusion time, ratios of bone cement diffusion area, and radiation dose of patients were significantly lower in the trial group than the control group (P<0.05). Bone cement leakage was observed in 6 cases of the control group (27.27%) and 2 cases of the trial group (7.69%), showing significant difference between groups (χ2=4.850,P=0.029); no cement leakage into the spinal canal was found in both groups. VAS score, relative vertebral body height in the anterior part, and posterior convex Cobb angle were significantly improved at 3 days and 6 months after operation when compared with preoperative ones (P<0.05), but no significant difference was observed in the above indexes between groups at 3 days and 6 months after operation (P>0.05). Conclusion Satisfactory effectiveness can be achieved by applying RCIM assisted PKP for the treatment of rupture of posterior vertebral osteoporotic vertebral fracture. RCIM can shorten perfusion time, reduce radiation dose, and decrease incidence of bone cement leakage.

关键词: 骨质疏松性椎体骨折; 远程遥控骨水泥推注系统; 经皮椎体后凸成形术

Key words: Osteoporotic vertebral fracture; remote controlled injection manipulator system; percutaneous kyphoplasty

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Watts NB, Harris ST, Genant HK. Treatment of painful osteoporotic vertebral compression fractures with percutaneous vertebroplasty or kyphoplasty. Osteoporos Int, 2011, 12(6): 429-437.
2. 钟远鸣, 付拴虎, 张家立, 等. 经皮穿刺椎体成形术中骨水泥渗漏的原因及预防. 中国矫形外科杂志, 2014, 22(4): 294-298.
3. Gan M, Yang H, Zhou F, et al. Kyphoplasty for the treatment of painful osteoporotic thoracolumbar burst fractures. Orthopedics, 2010, 33(2): 88-92.
4. 姜济世, 干阜生, 于海洋, 等. 经皮椎体后凸成形术治疗后壁破裂的骨质疏松性椎体骨折. 中国骨与关节损伤杂志, 2015, 30(3): 244-246.
5. 刘少军, 李涛, 王微慎, 等. 双侧穿刺逐级推注椎体后凸成形术治疗 A3 型骨质疏松性椎体压缩骨折. 颈腰痛杂志, 2016, 37(1): 73-75.
6. 宋晋刚, 苗艳, 崔易坤, 等. 椎体成形术治疗老年胸腰椎爆裂性骨折. 中国微创外科杂志, 2015, 15(2): 159-162.
7. 刘滔, 张志明, 史金辉, 等. 骨水泥温度梯度灌注技术在经皮椎体后凸成形术中的应用. 中国脊柱脊髓杂志, 2015, 25(12): 1073-1078.
8. Pradhan BB, Bae HW, Kropf MA, et al. Kyphoplasty reduction of osteoproptic vertebral compression fractures: correction of local kyphosis versus overall sagittal alignment. Spine (Phila Pa 1976), 2006, 31(4): 435-441.
9. 邓强, 李中锋, 张彦军, 等. 椎体成形术中骨水泥弥散面积和骨折类型及疗效关系. 实用中西医结合临床杂志, 2015, 15(11): 4-6.
10. 印平, 马远征, 马迅, 等. 骨质疏松性椎体压缩性骨折的治疗指南. 中国骨质疏松杂志, 2015, 21(6): 643-648.
11. Baerlocher MO, Saad WE, Dariushnia S, et al. Quality improvement guidelines for percutaneous vertebroplasty. J Vasc Interv Radiol, 2014, 25(2): 165-170.
12. 郝定均, 贺宝荣, 许正伟, 等. 经皮椎体成形术改为开放手术的原因分析. 中华骨科杂志, 2012, 32(10): 951-956.
13. 孙浩林, 李淳德, 朱佳琳, 等. PVP 或 PKP 治疗激素诱导骨质疏松性椎体压缩骨折的临床研究. 北京大学学报, 2015, 47(2): 242-247.
14. Kasbekar SA, Jones MN, Ahmad S, et al. Corneal transplant surgery for keratoconus and the effect of surgeon experience on deep anterior lamellar keratoplasty outcomes. Am J Ophthalmol, 2014, 158(6): 1239-1246.
15. 程喜红, 唐利民, 吴琦明, 等. 分次灌注增强椎体后壁破裂骨质疏松性椎体压缩骨折. 中国骨质疏松杂志, 2010, 16(6): 444-446.
16. 李波, 王群波, 余雨, 等. Confidence 高黏度椎体骨水泥椎体成形系统结合体位复位治疗急性重度骨质疏松性椎体压缩骨折. 中国修复重建外科杂志, 2011, 25(3): 307-310.
17. Tappero C, Barbero S, Costantino S, et al. Patient and operator exposure during percutaneous vertebroplasty. Radiol Med, 2009, 114(4): 595-607.
18. 蔡斌, 王文军, 宋西正, 等. 遥控骨水泥自动推进器辅助下经皮椎体成形术治疗骨质疏松性胸腰椎压缩性骨折. 中国矫形外科杂志, 2016, 24(10): 865-869.
19. 银和平, 白明. 遥控骨水泥推注装置在经皮球囊扩张椎体后凸成形术中的应用. 中国骨与关节损伤杂志, 2014, 29(1): 36-37.
20. 江晓兵, 莫凌, 梁德, 等. 骨水泥在椎体骨折线内弥散情况对椎体成形术治疗效果的影响. 中国脊柱脊髓杂志, 2014, 24(2): 144-149.
21. 严冬雪, 黄永吉, 肖增明, 等. 过伸体位复位在 PVP 治疗椎体压缩性骨折中的应用. 实用骨科杂志, 2013, 19(6): 521-524.