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  • Title: [A prospective study of vertebroplasty with reverse designed unilateral targeted puncture for osteoporotic thoracolumbar compression fractures].
    Author: Hao Y, Zhou Y, Zhuo H, Chai X, Huang Y.
    Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2022 Nov 15; 36(11):1400-1406. PubMed ID: 36382459.
    Abstract:
    OBJECTIVE: To explore the feasibility and effectiveness of vertebroplasty with reverse designed unilateral targeted puncture in treatment of osteoporotic vertebral compression fracture (OVCF) by comparing with curved unilateral puncture. METHODS: A total of 52 patients with OVCF met selection criteria and were admitted between January 2019 and June 2021 were selected as the research objects. According to the random number table method, they were divided into two groups ( n=26). In trial group, the reverse designed unilateral targeted puncture was used in the percutaneous vertebroplasty (PVP); while the control group used the curved unilateral puncture. There was no significant difference in gender, age, bone mineral density (T value), cause of injury, time from injury to operation, the level of responsible vertebral body, pedicle diameter of the planned puncture vertebral body, and preoperative visual analogue scale (VAS) score, anterior vertebral height, and Cobb angle between the two groups ( P>0.05). The operation time, bone cement injection volume and leakage, intraoperative radiation exposure times, and hospitalization costs in the two groups were recorded. VAS score was used to evaluate the relief degree of low back pain after operation. X-ray film was used to review the diffusion degree of bone cement in the responsible vertebral body, and Cobb angle and anterior vertebral height were measured. RESULTS: The operation was successfully completed in the two groups. Patients in the two groups were followed up 12-18 months, with an average of 13.6 months. The operation time, volume of injected bone cement, intraoperative radiation exposure times, and hospitalization costs in the trial group were significantly lower than those in the control group ( P<0.05). With the prolongation of time, the low back pain of the two groups gradually relieved, and the VAS score significantly decreased ( P<0.05). And there was no significant difference in VAS score between the two groups at each time point ( P>0.05). There were 2 cases (7.6%) of bone cement leakage in the trial group and 3 cases (11.5%) in the control group, and no significant difference was found in the incidence of bone cement leakage and the diffusion degree of bone cement between the two groups ( P>0.05). Imaging examination showed that compared with pre-operation, the anterior vertebral height of the two groups significantly increased and Cobb angle significantly decreased at 2 days and 1 year after operation ( P<0.05); while compared with 2 days before operation, the anterior vertebral height of the two groups significantly decreased and Cobb angle significantly increased at 1 year after operation ( P<0.05). There was no significant difference in the above indexes between the two groups at different time points after operation ( P>0.05). CONCLUSION: Compared with curved unilateral puncture, the use of reverse designed unilateral targeted puncture during PVP in the treatment of OVCF can not only achieve similar effectiveness, but also has the advantages of less radiation exposure, shorter operation time, and less hospitalization costs. 目的: 通过与弯角单侧穿刺椎体成形术比较，探讨逆向设计单侧椎弓根入路靶向穿刺椎体成形术治疗骨质疏松性椎体压缩骨折（osteoporotic vertebral compression fracture，OVCF）的可行性及疗效。. 方法: 以2019年1月—2021年6月收治且符合选择标准的52例OVCF患者作为研究对象，根据随机数字表法分为两组（ n=26）。经皮椎体成形术（percutaneous vertebroplasty，PVP）中，试验组采用逆向设计单侧椎弓根入路靶向穿刺，对照组采用弯角单侧穿刺。两组患者性别、年龄、骨密度T值、致伤原因、受伤至手术时间、责任节段、拟定穿刺侧椎弓根内壁直径，以及术前疼痛视觉模拟评分（VAS）、椎体前缘高度、Cobb角等一般资料比较，差异均无统计学意义（ P>0.05）。记录两组手术时间、术中骨水泥注入量及渗漏情况、术中射线暴露次数、住院费用，术后采用VAS评分评价腰背痛症状缓解程度，X线片复查责任椎体骨水泥弥散程度，测量Cobb角及椎体前缘高度。. 结果: 两组手术均顺利完成。患者均获随访，随访时间12～18个月，平均13.6个月。试验组手术时间、骨水泥注入量、术中射线暴露次数及住院费用均低于对照组（ P<0.05）。术后随时间延长，两组患者腰背痛均逐渐缓解，VAS评分逐渐降低（ P<0.05）；各时间点两组间VAS评分差异均无统计学意义（ P>0.05）。试验组发生骨水泥渗漏2例（7.6%），对照组3例（11.5%）；两组骨水泥渗漏率及弥散程度比较，差异均无统计学意义（ P>0.05）。影像学复查示与术前相比，两组术后2 d、1年椎体前缘高度均增加、Cobb角均减小；术后1年与术后2 d相比，椎体前缘高度均减小、Cobb角均增加；差异有统计学意义（ P<0.05）。术后各时间点两组椎体前缘高度及Cobb角比较，差异均无统计学意义（ P>0.05）。. 结论: 与弯角单侧穿刺相比，PVP术中采用逆向设计单侧椎弓根入路靶向穿刺治疗OVCF不仅能获得相似疗效，还具有射线暴露次数少、手术时间短、住院费用少等优势。.
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