经皮骨水泥椎间盘成形术治疗腰椎轴向失稳症的中期疗效

Mid-term efficacy of percutaneous cement discoplasty(PCD) in the treatment of axial lumbar instability

中文关键词:  骨水泥  椎间盘  真空征  腰椎失稳症  经皮骨水泥椎间盘成形术

英文关键词:Bone cement  Intervertebral disc  Vacuum sign  Intervertebral instability  Percutaneous cement discoplasty

中文摘要:

  【摘要】 目的：探讨经皮骨水泥椎间盘成形术（percutaneous cement discoplasty，PCD）治疗腰椎轴向失稳症的中期疗效、技术要点及适应证选择。方法：回顾性分析2018年1月~2019年12月于我科行PCD治疗的腰椎轴向失稳症患者9例，其中男性5例，女性4例，年龄62~87岁（75.7±8.2岁），随访时间0.5~3年（2.3±1.0年）。3例同时行3个椎间盘手术，3例行双间隙手术，另3例行单间隙手术；L2/3椎间盘3例，L3/4椎间盘3例，L4/5椎间盘4例，L5/S1椎间盘3例。术前行卧立位腰椎正侧位X线检查、腰椎CT三维成像及MRI检查，术后1d、3、6、12个月及末次随访时行腰椎X线及腰椎间盘CT检查，测量并记录术前术后椎间隙高度、责任椎间隙椎间孔矢状面积。术前、术后1d、3个月、6个月、12个月及末次随访时采用视觉模拟评分法（visual analogue scale，VAS）进行腰痛评分，采用Oswestry功能障碍指数（Oswestry disability index，ODI）进行腰椎功能评价。记录每个间隙骨水泥注入量、每个椎间盘手术操作时间及出血量。结果：所有患者均顺利完成手术，未发生骨水泥渗漏。术后各时间点VAS评分及ODI均较术前显著性改善（P<0.05）。每个椎间隙骨水泥注入量3.50±0.73mL，每个椎间盘手术操作时间16.33±1.28min，每个椎间盘手术出血量3.83±0.71mL。术后任一时间点责任间隙高度与术前相比均有差异（P<0.05），术后各时间点相比均无差异。术后任一时间点责任间隙椎间孔矢状面积与术前相比均有差异（P<0.05），术后1d和末次随访时有差异（P<0.05）。结论：PCD治疗腰椎轴向失稳症，术后椎间隙高度增加，腰痛缓解，疗效持久，中期疗效满意，不易发生骨水泥渗漏，较安全，但仍需长期大样本随访。

英文摘要:

  【Abstract】 Objectives: To investigate the mid-term outcomes of percutaneous cement discoplasty(PCD) in the treatment of lumbar axial instability, and analyze its technical keypoints and indications. Methods: A retrospective analysis was conducted on 9 patients with axial lumbar instability treated with PCD from January 2018 to December 2019. There were 5 males and 4 females, aged 62-87 years(75.7±8.2 years), with a follow-up period of 0.5-3 years, averaged 2.3±1.0 years. Three cases had three-disc operation at the same time, three had double-space operation and three had single-space operation, involving L2/3 disc in 3 cases, L3/4 disc in 3 cases, L4/5 disc in 4 cases, and L5/S1 disc in 3 cases. Lumbar anteroposterior and lateral radiographs in supine and standing positions were performed before operation, at postoperative 1d, 3, 6, 12 months and final follow-up to measure the height of intervertebral space of responsible level, as well as the sagittal area of intervertebral foramen at responsible level. Visual analogue scale(VAS) and Oswestry disability index(ODI) were used to evaluate the pain and function before surgery, at 1d, 3 months, 6 months, 12 months and final follow-up after operation to assess the clinical efficacy. The amount of bone cement injected in each intervertebral disc, the time of operation and the amount of blood loss were recorded respectively. Results: All the patients successfully completed the operation, no bone cement leakage occurred. The VAS score and ODI after operation were significantly improved compared with those before operation(P<0.05). The injection volume of bone cement per intervertebral disc was 3.50±0.73mL. The operative time of each disc was 16.33±1.28min, and the blood loss of each disc was 3.83±0.71mL. The height of intervertebral space of responsible level at various time points after operation was different from that before operation(P<0.05), and there was no difference in any two time points after operation. The sagittal area of intervertebral foramen at each time point after operation was different from that before operation(P<0.05), and there was difference between postoperative 1d and the final follow-up values(P<0.05). Conclusions: PCD can increase the height of the intervertebral space after surgery, relieve lumbar pain, and have a lasting effect in the treatment of lumbar instability, which is safe with satisfactory mid-term effect, and not prone to bone cement leakage, but long-term large-sample follow-up is still needed.