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  • Title: [Application of Curved Diffusion Needle in unilateral percutaneous vertebroplasty].
    Author: Huang H, Hu H, Lin X, Tan L, Wu C, Gao T, Wang X.
    Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2021 Dec 15; 35(12):1587-1594. PubMed ID: 34913316.
    Abstract:
    OBJECTIVE: To evaluate the effectiveness of Curved Diffusion Needle in unilateral percutaneous vertebroplasty (PVP) by compared with bilateral PVP. METHODS: A clinical data of 93 patients with osteoporotic vertebral compression fracture (OVCF) treated with PVP between January 2020 and January 2021 was retrospectively analyzed, including 47 patients underwent unilateral PVP assisted with Curved Diffusion Needle (unilateral group) and 46 patients underwent bilateral PVP (bilateral group). There was no significant difference in gender, age, cause of injury, time from injury to operation, T value of bone mineral density, AO classification, distribution of injured vertebrae, and preoperative visual analogue scale (VAS) score, Oswestry disability index (ODI), relative height of injured vertebrae, and Cobb angle between the two groups ( P>0.05). The operation time, the amount of bone cement injection, the incidence of bone cement leakage, the bone cement diffusion distribution, VAS score, ODI, the relative height of injured vertebrae, and Cobb angle were recorded and compared between the two groups. RESULTS: All operations successfully completed. The operation time was significantly shorter in unilateral group than in bilateral group ( t=-13.936, P=0.000), and the amount of bone cement injection was significantly less in unilateral group than in bilateral group ( t=-13.237, P=0.000). The incidence of bone cement leakage in unilateral group was 19.14%, which was significantly lower than that in bilateral group (39.13%) ( χ 2=4.505, P=0.034). The score of bone cement distribution in unilateral group was 7.0±1.3, of which 41 cases were excellent and 6 cases were well. The score of bilateral group was 7.4±0.8, of which 43 cases were excellent and 3 cases were well. There was no significant difference in score and grading of bone cement distribution between the two groups ( t=-1.630, P=0.107; Z=-1.013, P=0.311). All patients were followed up and the follow-up time was 3-10 months (mean, 6.5 months) in unilateral group and 3-10 months (mean, 6.1 months) in bilateral group. The VAS score, ODI, the relative height of injured vertebrae, and Cobb angle at 24 hours after operation and last follow-up were significantly better than those before operation in the two groups ( P<0.05). There were significant differences in all indicators between 24 hours after operation and last follow-up ( P<0.05). There was no significant difference in all indexes between the two groups ( P>0.05) at the same time point after operation. During follow-up, there was no complication such as contralateral vertebral collapse, refracture, adjacent vertebral fracture, or local kyphosis in the two groups. CONCLUSION: Unilateral PVP assisted with Curved Diffusion Needle for OVCF is beneficial to the distribution of bone cement, which can not only achieve similar effectiveness to bilateral PVP, but also achieve shorter operation time, less bone cement injection, and lower risk of bone cement leakage. 目的: 通过与双侧穿刺经皮椎体成形术（percutaneous vertebroplasty，PVP）比较，探讨采用弯角弥散导针行单侧穿刺PVP的疗效。. 方法: 回顾性分析2020年1月—2021年1月，行PVP治疗的93例骨质疏松性椎体压缩性骨折（osteoporotic vertebral compression fracture，OVCF）患者的临床资料。其中，47例采用弯角弥散导针行单侧穿刺PVP（单侧组），46例行双侧穿刺PVP（双侧组）。两组患者性别、年龄、致伤原因、受伤至手术时间、骨密度T值、骨折AO分型、伤椎分布以及术前疼痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）、伤椎相对高度、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。记录并比较两组手术时间、骨水泥注射量、骨水泥渗漏率、骨水泥弥散分布情况以及VAS评分、ODI、伤椎相对高度及Cobb角。. 结果: 两组患者均顺利完成手术，单侧组手术时间较双侧组缩短（ t=−13.936， P=0.000），骨水泥注射量较双侧组减少（ t=−13.237， P=0.000）。术中单侧组骨水泥渗漏发生率为19.14%，低于双侧组的39.13%，差异有统计学意义（ χ 2=4.505， P=0.034）。单侧组骨水泥分布评分为（7.0±1.3）分，其中优41例、良6例；双侧组评分为（7.4±0.8）分，其中优43例、良3例；两组骨水泥评分以及等级评价差异均无统计学意义（ t=−1.630， P=0.107； Z=−1.013， P=0.311）。两组患者均获随访，单侧组随访时间3～10个月，平均6.5个月；双侧组为3～10个月，平均6.1个月。组内术后24 h及末次随访时VAS评分、ODI以及伤椎相对高度、Cobb角均优于术前，差异有统计学意义（ P<0.05）；上述指标术后24 h与末次随访时比较，差异亦有统计学意义（ P<0.05）。两组间术后两时间点上述指标比较，差异均无统计学意义（ P>0.05）。随访期间两组均未出现伤椎对侧塌陷、再骨折、邻椎骨折及局部后凸畸形等并发症。. 结论: 单侧穿刺PVP治疗OVCF术中采用弯角弥散导针，有利于骨水泥分布，不仅能获得与双侧穿刺PVP相似疗效，且手术时间更短、骨水泥注射量更少、骨水泥渗漏发生风险更低。.
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