经皮椎体后凸成形术骨水泥分布形态对术后早期疗效的影响  

Clinical effects of types of bone cement distribution in percutaneous kyphoplasty

作　　者：贺双军 吕南宁[1] 刘昊 张长昊[1] 梁效 周张喆 陈康武 孙智勇[1] 朱晓宇[1] 钱忠来[1] 杨惠林[1] He Shuangjun;Lyu Nanning;Liu Hao;Zhang Changhao;Liang Xiao;Zhou Zhangzhe;Chen Kangwu;Sun Zhiyong;Zhu Xiaoyu;Qian Zhonglai;Yang Huilin(Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Suzhou 215006, China;Department of Orthopaedics, the People's Hospital of Danyang, Danyang 212300, China)

机构地区：[1]苏州大学附属第一人民医院骨科,215006 [2]丹阳市人民医院骨科,212300

出　　处：《中华骨科杂志》2019年第3期137-143,共7页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(81802682,81802132);江苏省自然科学基金(BK20180199).

摘　　要：目的 探讨经皮椎体后凸成形术的骨水泥分布形态对术后早期疗效的影响。方法 2015年1月至2017年7月收治骨质疏松性椎体压缩骨折患者312例,男54例,女258例;年龄(69.37±9.39)岁(范围52~95岁)。根据术后脊柱正侧位X线片中骨水泥的分布特点,将患者分为两组:“O”型组(113例113椎),骨水泥于椎体内呈现一个整体团块状,中间没有间隔或骨水泥缺失;“H”型组(199例199椎),骨水泥于椎体内呈现两个团块,中间有或没有少量骨水泥相连。采用单侧或双侧经椎弓根入路椎体后凸成形术,使用球囊扩张椎体,椎体中注入骨水泥。比较两组患者骨密度T值、术前、术后第2天及术后1年疼痛视觉模拟评分(visual analogue scale,VAS)、骨水泥注入量、伤椎前缘高度、伤椎中线高度、局部后凸Cobb角和骨水泥渗漏率。结果 两组患者的骨密度T值、手术时间、术中出血量、骨水泥渗漏率的差异均无统计学意义(P>0.05)。“H”型组骨水泥注入量较“O”型组多(t=7.321,P<0.001)。“O”型组单侧入路较“H”型组多(χ^2=31.235,P<0.001)。两组术后第2天、术后1年VAS评分与术前比较明显下降,差异有统计学意义(P<0.05);“H”型组术后1年VAS评分与术后第2天比较明显下降,差异有统计学意义(t=3.502,P<0.001)。术前、术后第2天VAS评分的组间比较差异无统计学意义(P>0.05),术后1年时“H”型组VAS评分小于“O”型组(t=3.631,P<0.001)。两组术后第2天、术后1年局部后凸Cobb角与术前比较明显减小(P<0.05),而组间差异均无统计学意义(P>0.05)。两组术后第2天、术后1年伤椎前缘高度与术前比较明显增加(P<0.05),而组间比较差异均无统计学意义(P>0.05)。两组术后第2天、术后1年伤椎中线高度与术前比较有提高(P<0.05);而组间比较差异均无统计学意义(P>0.05)。结论 经皮椎体后凸成形术的骨水泥分布基本可分为“O”型和“H”型,均可获得满意的�Objective To investigate the impact of various distribution of bone cement on the early clinical outcomes in osteoporotic vertebral compression fracture (OVCF) patients treated with percutaneous kyphoplasty (PKP). Methods A total of 312 patients (54 males and 258 females, mean age 69.37 years) who diagnosed as OVCF and received PKP treatment from January 2015 to July 2017 were enrolled in the present study. All subjects were divided into two groups according to different distribution of bone cement: the shaped “O” distribution (group O, 113 cases), in which bone cement in the vertebral body presented whole crumb, no separation or loss of bone cement, and the shaped “H” distribution (group H, 199 cases), in which bone cement in the vertebral body presented two briquettes, connected with or without a small amount of bone cement. Demographic data, surgical details, radiographic data, and clinical outcomes (at preoperatively, two-days and one-year follow-up) were compared between the two groups. Results There was no significant difference in bone mineral density (BMD), operation duration, blood loss, and occurrence of leakage of bone cement between two groups. In comparison with group O, group H was accompanied with higher volume of injected bone cement and higher proportion of bilateral approach (P<0.05). Both groups achieved significant improvement of VAS scores after surgery, while the group H had a dramatical reduction of VAS scores at one-year follow-up compared with two-days follow-up (P<0.05). In addition, group H had a better restoration of VAS scores at one-year follow-up than group O (P<0.05), though no significant difference was observed at preoperative and two-days follow-up. Both groups achieved significant improvement of radiographic data after surgery (P<0.05) with similar effects of correction. Conclusion Either shaped “H” or shaped“O” distribution of bone cement can obtain satisfied early clinical effects of PKP for the treatment of OVCF. Compared with shaped “O” distribution, sha

关 键 词：骨质疏松 骨折 压缩性 椎体后凸成形术 

分 类 号：R687.3[医药卫生—骨科学]