磷酸钙骨水泥与传统骨水泥后凸成形术治疗骨质疏松性椎体骨折的比较  

Calcium phosphate cement versus polymethylmethacrylate cement in the percutaneous kyphoplasty of osteoporotic vertebral fractures

作　　者：贾小林[1] 谭祖键[1] 杨阜滨[1] Thomas Stoffels 

机构地区：[1]重庆市中山医院骨科,400013 [2]柏林创伤中心骨科,德国12683

出　　处：《中国骨与关节杂志》2016年第5期391-394,共4页Chinese Journal of Bone and Joint

基　　金：重庆市卫生局医学科研项目(2011-2-368)

摘　　要：目的比较骨质疏松性椎体压缩骨折磷酸钙骨水泥（calcium phosphate cement,CPC）椎体后凸成形术与聚甲基丙烯酸甲酯骨水泥（polymethylmethacrylate,PMMA）椎体后凸成形术的临床疗效。方法回顾性分析2011年7月至2013年5月,我院进行椎体后凸成形术的治疗的48例骨质疏松性单个椎体压缩骨折患者的临床资料。CPC组23例,其中男9例,女14例,年龄61-82岁,平均69.59岁;PMMA组25例,其中男11例,女14例,年龄67-89岁,平均71.23岁。所有患者在术前、术后即刻、术后3、6、12、24个月进行随访检查。评价比较视觉模拟评分（visual analogue scale,VAS）、止痛药持续使用时间、手术满意度、椎体压缩率、局部后凸畸形及并发症的发生率。结果两组患者的年龄、性别、受伤后至手术的间隔时间差异无统计学意义。术后VAS评分、止痛药持续使用时间、手术满意度、椎体高度恢复及局部后凸畸形两组间差异无统计学意义（P〉0.05）,均较术前明显好转。继发骨折及骨水泥渗漏两组差异无统计学意义（P〉0.05）。CPC组术后3个月及末次随访时椎体压缩率分别为（23.26±10.08）%、（23.39±11.23）%,较术后即刻的（17.22±14.19）%椎体高度有所丢失,差异有统计学意义（P〈0.05）。结论对于骨质疏松性椎体压缩骨折行椎体后凸成形术,CPC与PMMA一样安全有效,可以缓解疼痛、提高活动能力,但CPC术后椎体高度恢复后会有部分丢失。Objective To compare the clinical and radiographic outcomes after percutaneous kyphoplasty （ PKP ） using calcium phosphate cement （ CPC ） versus polymethylmethacrylate （ PMMA ） for osteoporotic vertebral fractures. Methods The study was conducted on 48 patients from July 2011 to May 2013. Twenty-three patients （ 9 males and 14 females ） with an average age of 69.59 （ range： 61 - 82 years ） received CPC. Twenty-five patients （ 11 males and 14 females ） with an average age of 71.23 （ range： 67 - 89 years ） were treated with PMMA-cement. Pain （ visual analog scale, VAS ）, duration of analgesics, operation satisfaction rate, radiomorphologic measurements and complications were assessed at baseline and after 3, 6, 12, and 24 months. Results There were no statistically significant differences between the CPC and PMMA group regarding VAS-scores, duration of analgesics, operation satisfaction rate, degree of vertebral compression or local kyphosis at any time point （ P 〉 0.05 ）. Furthermore, there were no significant differences in the occurrence of adjacent vertebral fractures and cement leakage between both groups during the follow-up （ P 〉 0.05 ）. However, the compression rates of the vertebrae in the CPC group were （ 17.22 ± 14.19 ） % after the operation immediately, （ 23.26± 10.08 ） % 3 months postoperatively, and （ 23.39± 11.23 ） % at the final follow-up. There was a significant correction loss of vertebral height at the 3-month follow-up and from then on （ P 〈 0.05 ）. Conclusions CPC is as effective and safe as conventional PMMA-cement with regard to pain reduction and improvement of mobility after the kyphoplasty of patients with painful osteoporotic vertebral fractures.

关 键 词：骨质疏松性骨折 骨折 压缩性 脊柱骨折 椎体后凸成形术 骨水泥成形术 

分 类 号：R687.3[医药卫生—骨科学] R580[医药卫生—外科学]