微创医学

目的探讨采用无射线接触体外数字伤椎定位结合探针应用椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗胸腰椎骨质疏松性压缩性骨折的疗效。方法采用无射线接触体外数字伤椎定位结合探针应用PKP治疗T11-L2胸腰椎骨质疏松性压缩性骨折患者16例。根据术前DR正位片以髂后上嵴上缘连线为体外参照物向上测量距伤椎椎弓根窗中点距离,沿棘突中线向两侧测量距椎弓根窗外上象限距离选择进针点,根据CT片、DR侧位片选择进针角度,使用C型臂X光机透视1~2次即可微调准确选择伤椎及进针点、角度,经穿刺、套管植入、扩孔、球囊扩张,透视复位满意,再完成聚甲基丙烯酸甲酯(PMMA)植入。采用X线片测定术前、术后Cobb角及椎体前后缘高度比值,VAS法进行疼痛评分评定疗效。结果术中出血量5~30 mL,平均10 mL。手术时间30~60 min,平均50 min。术中无脊髓神经损伤、气胸、PMMA渗漏、肺栓塞等并发症。术后16例经摄片提示椎体定位无误,住院时间5~12 d,平均8 d。16例随访3~24个月,平均12个月。疼痛VAS评分由术前(7.38±1.09)分恢复为术后1周的(1.06±0.44)分,并维持稳定。Cobb’s角由术前(21.81±2.56)°恢复为术后1周的(8.19±3.41)°,并维持稳定。椎体前后缘高度比值由术前(51.10±4.69)%恢复为术后1周的(84.97±7.44)%,并维持稳定,差异均有统计学意义(P<0.01)。结论采用无射线接触体外数字伤椎定位结合探针应用PKP治疗胸腰椎骨质疏松性压缩性骨折,可明显减少术中C形臂X光机定位照射次数,减少医患双方X射线接触量,手术安全、可行,适用于T8~L5范围骨质疏松性压缩性骨折手术。

Objective To explore the therapeutic effect of percutaneous kyphoplasty( PKP) with in vitro digital localization without X-ray contact combined with probe application in the treatment of thoracolumbar vertebral compressed fractures． Methods Sixteen cases of T11-L2 thoracolumbar osteoporotic compressed fractures were treated by PKP with no X-ray contact digital localization combined with probe application． According to preoperative DＲ frontal and posterior iliac crest on the edge of the connection to the external reference from the vertebral pedicle window midpoint distance，the point up the middle to both sides was measured; along the spine pedicle out upper quadrant of distance measurement range，the needle entering point was selected; according to CT and DＲ side position piece，the needle point of view was chosen; after using C-arm X-ray perspectively 1 － 2 times，the vertebral and needle puncture point could be finely tuned and located; through the puncturing，casing implantating，reaming，balloon dilatating，and perspective satisfactory of resetting，the polymethyl methacrylate ( PMMA) was implanted． The vertebral Cobb’ s angle，anterior and posterior edge of vertebral body height ratio according to the X-ray films，Visual Analogue Scale( VAS) of the preoperative and postoperative pain score were measured for the evaluation of curative effect before and after surgery．Ｒesults The amount of bleeding was 5 － 30 ml，averaging 10 ml． Operation time was 30 － 60 min， averaging 50 min． No intraoperative spinal cord injury，pneumothorax，PMMA leakage，or pulmonary embolism was reported． Sixteen cases of postoperative X-ray showed accurate vertebral correct positioning． Hospitalization time was 5 － 12d，averaging 8d． All patients were followed up for 3 － 24 months，averaging 12 months． Pain VAS score decreased from preoperative ( 7． 38 ± 1． 09) weeks to ( 1． 06 ± 0． 44) 1 week after operation，and maintained stable since． Cobb’s angle from preoperative ( 21． 81 ± 2． 56) ° recovered to ( 8． 19 ± 3． 41) °1 week after operation，and maintained stable since． Anterior and posterior edge of vertebral body height ratio from preoperative ( 51． 10 ± 4． 69) % restored to ( 84． 97 ± 7． 44) % 1 week after operation，and maintained stable since． The differences were all statistically significant ( P ＜ 0． 01 ) ． Conclusion Percutaneous kyphoplasty with in vitro digital localization without X-ray contact combined with probe application for the treatment of thoracolumbar vertebral compressed fractures can obviously reduce the C-arm X-ray irradiation times and the doctor-patient X-ray exposure． It is safe and feasible to osteoporotic compressed fracture operationof T8 － L5．