【摘要】 目的探讨椎弓根外穿刺法在骨填充网袋椎体后凸成形术中的应用价值。方法选择2016年3月～2017年3月45例骨质疏松性椎体压缩骨折行骨填充网袋椎体后凸成形术,抛币法分为A组(n=24)和B组(n=21),分别采取椎弓根外入路及经椎弓根入路穿刺。记录网袋位置、手术时间、穿刺曝光次数、骨水泥注射量、骨水泥渗漏、术后3天及1个月疼痛视觉模拟评分(Visual Analogue Scale,VAS)。结果手术均顺利完成。A组22例(91. 7%)实现网袋中置,B组8例(38. 1%)网袋中置,A组明显高于B组(χ~2=14. 464,P=0. 000)。A组手术时间明显短于B组[(19. 0±1. 8) min vs.(22. 6±3. 3) min,t=-3. 080,P=0. 004]。A组曝光次数明显少于B组[(7. 1±1. 2)次vs.(13. 8±1. 8)次,t=-14. 832,P=0. 000]。2组骨水泥注入量差异无统计学意义[(4. 16±0. 66) ml vs.(3. 89±0. 60) ml,t=1. 449,P=0. 155]。2组各发生2例骨水泥渗漏(A组8. 3%,B组9. 5%),组间差异无统计学意义(χ~2=0. 000,P=1. 000)。术后3天VAS评分A组明显高于B组[中位数2分(1～4) vs. 3分(1～5),Z=-2. 145,P=0. 032],术后1个月2组差异无统计学意义[均为中位数2分(1～3),Z=-1. 708,P=0. 088]。结论骨填充网袋椎体后凸成形术中应用椎弓根外穿刺法能提高穿刺的准确性和安全性,减少射线暴露,缩短穿刺时间。更多还原

【Abstract】 Objective To discuss the advantages of extrapedicular puncture applied in vesselplasty. Methods From March 2016 to March 2017,a total of 45 patients with osteoporotic vertebral fractures were randomly divided into group A( n = 24) or group B( n = 21) with coin throwing method. They received vesselplasty by either extrapedicular( group A) or transpedicular puncture( group B). The location of mesh,operation time,times of X-ray exposure,volume of cement injection and cement leakage,as well Visual Analogue Scale( VAS) score at postoperation day 3 and 1 month were documented and compared. Results All the patients underwent operations successfully. The meshes were placed medially in 22 out of 24 patients( 91. 7%) in group A,while only in 8 out of 21 patients( 38. 1%) in group B( χ~2= 14. 464,P = 0. 000). The operation time was much shorter in patients of group A [( 19. 0 ±1. 8) min] as compared to that of group B [( 22. 6 ± 3. 3) min,t =-3. 080,P = 0. 004]. The X-ray exposure times also favored patients of group A than group B [( 7. 1 ± 1. 2) vs.( 13. 8 ± 1. 8) times,t =-14. 832,P = 0. 000]. The volume of cement injection[( 4. 16 ± 0. 66) ml vs.( 3. 89 ± 0. 60) ml,t = 1. 449,P = 0. 155] and cement leakage( two patients in each group,χ~2= 0. 000,P = 1. 000) were comparable between the two groups. We noted statistical difference in VAS scores at postoperation day 3 [2( 1-4)in group A vs. 3( 1-5) in group B,Z =-2. 145,P = 0. 032]. But at 1 month postoperation,the difference was not statistically significant [2( 1-3) in group A vs. 2( 1-3) in group B,Z =-1. 708,P = 0. 088]. Conclusions Extrapedicular puncture in vesselplasty increases the accuracy and safety of puncture. It is also associated with shorter X-ray exposure and puncture time.更多还原