经皮椎体成形术中椎体内骨水泥分布范围对疗效的影响  

Influence of bone cement distribution in injured vertebra on clinical results in percutaneous vertebroplasty

作　　者：俞武良[1] 陆建猛[1] 韦勇力[1] 王兴武[1] 方明[1] 欧阳甲[1] 

机构地区：[1]宁波大学医学院附属医院脊柱外科,315020

出　　处：《中国矫形外科杂志》2015年第20期1836-1840,共5页Orthopedic Journal of China

摘　　要：[目的]探讨经皮椎体成形术中骨水泥在椎体内分布范围对临床疗效的影响。[方法]对2013年6月-2014年6月确诊为骨质疏松性压缩性骨折并行经皮椎体成形术治疗的60例患者进行回顾性研究,参照术后X线片或CT重建判断骨水泥在椎体内的分布情况,将患者分为3组,A组：骨水泥没有弥散于骨折线区域;B组：骨水泥仅弥散于骨折线区域;C组：骨水泥弥散于整个椎体。记录术前、术后第3 d、术后3、6个月时的疼痛视觉模拟疼痛评分（VAS）及Oswestry功能障碍指数（ODI）评分,对3组患者不同时间点的疼痛程度及个人生活情况进行比较分析。[结果]所有患者均顺利完成手术,无严重并发症发生。术中骨水泥注射量为3.5-6.0 ml,平均（4.7±0.8）ml。3组患者术后疼痛及生活质量明显改善,术后第3 d,第3、6个月VAS评分及ODI与术前相比,差异有统计学意义（P〈0.05）。A组和B、C组患者术后3 d VAS评分及ODI分别对比差异均有统计学差异（P〈0.05）,B、C组患者术后第3 d VAS评分及ODI对比,差异无统计学意义（P〉0.05）,3组患者术后3、6个月VAS评分及ODI分别比较,差异均无统计学意义（P〉0.05）。B、C两组患者术后即时疗效较A组明显,随访3个月后3组患者疗效差异不明显。[结论]骨质疏松性压缩性骨折患者行经皮椎体成形术后,在疼痛及生活质量上均有明显改善,椎体内骨水泥是否弥散于骨折线区域可能是影响椎体成形术疗效的因素之一。[Objective]To investigate the influence of cement distribution in injured vertebra on clinical results in percutaneous vertebroplasty（ PVP）.[Method]From June 2013 to June 2014,60 patients undergoing PVP in treatment of osteoporotic vertebral compression fractures（ OVCF） in our department were retrospectively analysed.According to cement distribution in injured vertebra on X-ray or CT scan after operation,the patients were divided into three groups（ 20 cases in each）,i.e.no dispersive distribution of cement in fracture zone（ group A）,only distribution of cement in fracture zone（ group B） and dispersive distribution of cement in whole veterbra（ group C）.The pain and quality of life were recorded by visual analogue scale（ VAS）and Oswestry Disability Index（ ODI） preoperatively and postoperatively.[Result]All the 60 patients had successful operation and no severe complications.The volume of cement usage per vertebra was 3.5-6.0 ml（ 4.7 ± 0.8） ml.The results of VAS and ODI were improved significantly after operation.The results of VAS and ODI in three groups had significant differences between preoperatively and postoperatively（ at 3 day,3 months and 6 months after operation）（ P〈0.05）.The results of VAS and ODI in group B and C were better than that of group A at 3 days after operation（ P〈0.05）,but there were no significant differences between group B and group C（ P〈0.05）.At 3 and 6 months after operation,there were no significant differences in the results of VAS and ODI between three groups（ P〈0.05）.After the operation,the instant results of VAS and ODI in group B and C were better than that of group A,but the results among three groups were no obviously different at 3 months and later on.[Conclusion]The clinical results of PVP in treatment of OVCF were satisfactory.The pain had released and the quality of life had improved significantly.The distribution pattern of cement in injured vertebra is one of key factors that affect clinical result finally.

关 键 词：骨质疏松性骨折 椎体成形术 骨水泥 分布范围 

分 类 号：R687.3[医药卫生—骨科学]