不同方式灌注骨水泥治疗骨质疏松性椎体压缩骨折的比较  

Different bone cement implantation ways for osteoporotic vertebral compression fractures

作　　者：周伟 刘贵省 周丽萍[3] 高芳[3] 刘训伟[3] 谢志勇[3] 

机构地区：[1]莒县人民医院介入科,山东省莒县276500 [2]郓城县人民医院放射科,山东省郓城县274700 [3]解放军济南军区总医院医学影像科,山东省济南市250031

出　　处：《中国组织工程研究》2017年第14期2147-2152,共6页Chinese Journal of Tissue Engineering Research

基　　金：国家高技术研究发展计划(863计划)资助(2013AA032203)~~

摘　　要：背景:骨水泥灌注治疗骨质疏松性椎体压缩骨折后,随着骨质疏松的进行和骨水泥与骨组织间隙的增大,骨水泥-骨界面的抗压缩和抗扭转能力下降,骨水泥块在椎体内的微运动幅度增加,易导致伤椎再骨折发生。目的:探讨3种方式灌注骨水泥治疗骨质疏松性椎体压缩骨折的临床疗效。方法:以单椎体骨质疏松性压缩骨折患者为研究对象,进行椎体成形术、椎体后凸成形术及椎体成形术分次灌注骨水泥治疗各60例,整理相关数据,分析椎体内骨水泥块的类别与治疗方式的关系,了解患者长期疼痛缓解及日常活动功能改善、椎体高度及骨水泥块形态位置改变、伤椎再骨折发生等情况。结果与结论:(1)3组治疗后的目测类比评分、Oswestry功能障碍指数和Cobb's角均较治疗前改善(P<0.05);治疗后6个月与末次随访相比差异无显著性意义,各时间点组间相比差异无显著性意义,说明3种方法缓解疼痛和恢复行动的效果无差异,均能够防止椎体高度丢失,维护脊柱的力学性能;(2)骨水泥形态位置发生改变及伤椎再骨折均出现在团块型骨水泥病例中,为增加长期疗效,在灌注骨水泥时应尽可能在椎体内形成混合型或骨小梁型骨水泥。BACKGROUND： After the treatment of osteoporotic vertebral compression fractures with bone cement implantation, deteriorative osteoporosis and the distance augment between bone cement and bones result in a decrease in bone cement-bone interface compression strength and torsion strength, and then the bone cement tends to displace, which is easy to cause a secondary vertebral fracture. OBJECTIVE： To investigate the clinical efficacy of bone cement implantation via three approaches on osteoporotic vertebral compression fractures. METHODS： Sixty patients with single osteoporotic vertebral compression fracture were treated with vertebroplasty, percutaneous kyphoplasty or fraction cement vertebroplasty. All data were collected to analyze the correlation between the bone cement morphology and treatment method, and to detect the visual analogue scale, Oswestry disability index, Cobb angle and incidence of secondary vertebral fractures. RESULTS AND CONCLUSION： The visual analogue scale scores, Oswestry disability index, and Cobb angle in the three groups were significantly improved after treatment （P 〈 0.05）. All above indicators showed no significant difference among groups at each time point after treatment, suggesting that these three kinds of treatments exert the same effects on pain relief, functional recovery, preventing the vertebral height loss and maintaining spinal mechanical properties. Bone cement displacement and secondary vertebral fracture occurred after clotted cement implantation. Therefore, mixed and trabecular-shaped grafts are preferred, aiming to achieve good long-term treatment outcomes in osteoporotic vertebral compression fractures.

关 键 词：骨质疏松性骨折 骨折 压缩性 椎体成形术 丙烯酸树脂类 组织工程 生物材料 骨生物材料 骨质疏松症 椎体压缩骨折 经皮椎体成形术 经皮椎体后凸成形术 

分 类 号：R318[医药卫生—生物医学工程]