经皮椎体后凸成形术后骨水泥弥散形态影响因素分析及其对手术疗效的影响
Analysis of influencing factors of bone cement diffusion morphology in percutaneous kyphoplasty and its effect on curative effect
胡文均 1郑杰文 1简思莹 2许洋军 3陈卓林 3郦鑫火4
作者信息
- 1. 绍兴文理学院附属医院骨科,浙江绍兴 312000
- 2. 绍兴文理学院附属医院手术室,浙江绍兴 312000
- 3. 绍兴市人民医院骨科,浙江 312035
- 4. 温州医科大学,浙江温州 325031
- 折叠
摘要
目的 分析经皮椎体后凸成形术后骨水泥弥散形态的影响因素及其对手术疗效的影响.方法 回顾性分析自2018-01-2020-12行经皮椎体后凸成形术治疗的173例单节段骨质疏松性椎体压缩骨折,根据术后骨水泥弥散大体形态分为团块组(n=78)和分团连接组(n=95).比较两组的骨密度值、骨折至手术时间、手术穿刺途径(单侧或双侧)、骨水泥注射时间、骨水泥量等因素差异;记录两组并发症发生情况及术后骨水泥渗漏情况,比较两组术后1d、术后1年疼痛VAS评分及ODI指数.结果 所有患者均获得随访,随访时间12～28个月,平均20.5个月.团块组7例出现骨水泥渗漏,分团连接组10例出现骨水泥渗漏,两组骨水泥渗漏率差异无统计学意义(x2=0.007,P=0.933).两组均未发生血管神经损伤、感染、脑脊液漏及肺栓塞等并发症.两组骨密度值、骨水泥量差异无统计学意义(P＞0.05),但是相较于分团连接组,团块组骨折至手术时间较长、采用单侧穿刺比例更高、骨水泥注射时间偏向于拉丝期晚期,两组差异均有统计学意义(P＜0.05).两组术后1d、术后1年疼痛VAS评分及ODI指数均较术前明显改善,且团块组术后1d、术后1年疼痛VAS评分及ODI指数均较分团连接组高,差异均有统计学意义(P＜0.05).结论 经皮椎体后凸成形术后骨水泥弥散形态受穿刺途径、骨水泥注射时间、骨折至手术时间影响,而且骨水泥弥散形态对手术疗效有一定影响,骨水泥弥散呈分团连接形的患者症状缓解效果更明显.
Abstract
Objective To analyse factors influencing bone cement dispersion patterns after percutaneous kyphoplasty and their impact on surgical outcomes.Methods A retrospective analysis was conducted on 173 cases of single-segment osteoporotic vertebral compression fractures treated with percutaneous kyphoplasty from January 2018 to December 2020.The patients were categorized based on the macroscopic morphology of postoperative cement dispersion into the lump group(n=78)and the con-nected lump group(n=95).The differences between the two groups were compared in terms of bone mineral density,time from fracture to surgery,surgical puncture approach(unilateral or bilateral),cement injection time,and cement volume.Complica-tions and postoperative cement leakage were recorded for both groups,and the postoperative pain VAS score and ODI index were compared at 1 day and 1 year postoperatively.Results All patients were followed up for 12 to 28 months,with an average of 20.5 months.Cement leakage was observed in 7 cases in the lump group and 10 cases in the connected lump group;the differ-ence in cement leakage rates between the two groups was not statistically significant(x2=0.007,P=0.933).No complications such as vascular nerve injury,infection,cerebrospinal fluid leakage,or pulmonary embolism were observed in either group.There were no statistically significant differences between the two groups in terms of bone mineral density and cement volume(P＞0.05).However,compared to the connected lump group,the lump group had a longer time from fracture to surgery,a higher proportion of unilateral puncture,and a tendency for cement injection to occur in the late filamentous stage,all of which showed statistically significant differences(P＜0.05).Both groups showed significant improvement in pain VAS scores and ODI indices at 1 day and 1 year postoperatively compared to preoperative values.However,the lump group had significantly higher pain VAS scores and ODI indices at both 1 day and 1 year postoperatively compared to the connected lump group(P＜0.05).Conclusion The dispersion morphology of bone cement following percutaneous kyphoplasty is influenced by the puncture ap-proach,the timing of cement injection,and the interval from fracture to surgery.Moreover,the morphology of cement dispersion affects the surgical outcomes to some extent.The patients with a connected lump dispersion pattern experience more pro-nounced symptom relief.
关键词
椎体压缩骨折/经皮椎体后凸成形术/骨水泥/骨质疏松Key words
Percutaneous kyphoplasty/Osteoporosis/Fracture/Bone cement引用本文复制引用
基金项目
绍兴市卫生健康科技计划项目(2023SKY088)
出版年
2024
NETL
NSTL
万方数据