CAJ | 학술논문

背景：经皮椎体成形、经皮椎体后凸成形用于传统方法治疗无效的骨质疏松性椎体压缩性骨折效果良好，但在手术时机、麻醉方式、手术入路及方式等方面存在多种选择，并各有利弊。目的：观察全身麻醉下手法复位联合单侧经皮椎体成形治疗骨质疏松性椎体压缩性骨折的效果及优势。方法：2012年7月至2014年12月回顾经皮椎体成形治疗单椎体骨质疏松性椎体压缩性骨折患者53例，新方法组32例在全身麻醉下先行手法复位，再行单侧椎弓根穿刺，单侧经皮椎体成形骨水泥注射治疗；常规方法组21例采用常规的经皮椎体成形操作治疗。结果与结论：随访时间平均6个月(3-14个月)。两组患者术后3 d、术后末次随访的目测类比评分、椎体压缩率、后凸Cobb’s角均较术前显著改善，差异有显著性意义(P <0.01)。两组目测类比评分术后比较差异无显著性意义(P >0.05)。与常规方法组相比，新方法组术后椎体压缩率、后凸Cobb’s角及骨水泥渗漏率明显降低(P <0.01)。结果证实，新方法综合了经皮椎体成形与经皮椎体后凸成形的优势、单侧与双侧穿刺的优势，穿刺过程更安全，矫正后凸畸形、恢复椎体高度及生理曲度更好，同时骨水泥渗漏的危险性减少，骨水泥的形态分布更理想。
배경：경피추체성형、경피추체후철성형용우전통방법치료무효적골질소송성추체압축성골절효과량호，단재수술시궤、마취방식、수술입로급방식등방면존재다충선택，병각유리폐。목적：관찰전신마취하수법복위연합단측경피추체성형치료골질소송성추체압축성골절적효과급우세。방법：2012년7월지2014년12월회고경피추체성형치료단추체골질소송성추체압축성골절환자53례，신방법조32례재전신마취하선행수법복위，재행단측추궁근천자，단측경피추체성형골수니주사치료；상규방법조21례채용상규적경피추체성형조작치료。결과여결론：수방시간평균6개월(3-14개월)。량조환자술후3 d、술후말차수방적목측류비평분、추체압축솔、후철Cobb’s각균교술전현저개선，차이유현저성의의(P <0.01)。량조목측류비평분술후비교차이무현저성의의(P >0.05)。여상규방법조상비，신방법조술후추체압축솔、후철Cobb’s각급골수니삼루솔명현강저(P <0.01)。결과증실，신방법종합료경피추체성형여경피추체후철성형적우세、단측여쌍측천자적우세，천자과정경안전，교정후철기형、회복추체고도급생리곡도경호，동시골수니삼루적위험성감소，골수니적형태분포경이상。
BACKGROUND:Percutaneous vertebroplasty and percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fracture have obtained good outcomes, because the traditional method is invalid, but there are a variety of choices in operation time, anesthesia, surgical approach and method, and each method has its advantages and disadvantages. OBJECTIVE:To investigate the effect and preponderance of the manual reduction combined with unilateral percutaneous vertebroplasty under general anesthesia in the treatment of osteoporotic vertebral compression fractures. METHODS:A total of 53 patients with single vertebral osteoporotic vertebral compression fractures, who were treated with percutaneous vertebroplasty, were retrospectively analyzed from July 2012 to December 2014. The new method group (32 cases) received manual reduction, underwent unilateral pedicle puncture and bone cement injection during unilateral percutaneous vertebroplasty under general anesthesia. The conventional method group (21 cases) received conventional percutaneous vertebroplasty. RESULTS AND CONCLUSION: There was an average of 6-month folow-up (3-14 months). Significant differences in visual analogue scale scores, vertebral compression ratio and kyphosis Cobb’s angle were detected in the new method and the conventional method groups at 3 days post surgery and during final folow-up compared with before surgery (P < 0.01). No significant difference in visual analogue scale scores was found between the two groups (P > 0.05). Compared with the conventional method group, postoperative vertebral compression ratio, kyphosis Cobb’s angle and bone cement leakage rate were significantly lower in the new method group (P < 0.01). Results verified that the new method combined with the advantages of percutaneous vertebroplasty and percutaneous kyphoplasty, the advantages of unilateral and bilateral puncture approach. The new method can correct kyphosis deformity, effectively recover the vertebral height and physiological curvature and the puncture is safe. Simultaneously, the leakage rate of bone cement is reduced, and the distribution of bone cement is ideal.