不同时相骨水泥推注对经皮椎体后凸成形术治疗骨质疏松性椎体压缩性骨折疗效的影响  

Effect of percutaneous kyphoplasty with different phases bone cement for treatment of osteoporotic vertebral compression fractures

作　　者：刘志强 周云龙[2] 雷飞 叶飞 周庆忠 郑礼鹏 冯大雄 LIU Zhiqiang;ZHOU Yunlong;LEI Fei;YE Fei;ZHOU Qingzhong;ZHENG Lipeng;FENG Daxiong(Department of Spine Surgery,the Affiliated Hospital of Southwest Medical University,Luzhou Sichuan,646000,P.R.China;Departmen of Spine Surgery,the People’s Hospital of Leshan,Leshan Sichuan,614000,P.R China)

机构地区：[1]西南医科大学附属医院脊柱外科,四川泸州646000 [2]乐山市人民医院脊柱外科,四川乐山614000

出　　处：《中国修复重建外科杂志》2020年第4期435-441,共7页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的比较不同时相骨水泥推注对经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松性椎体压缩性骨折(osteoporotic vertebral compression fracture,OVCF)疗效的影响。方法回顾分析2016年6月—2018年5月采用PKP治疗并符合选择标准的219例OVCF患者临床资料,根据术中推注骨水泥时相不同分为观察组[116例,术中推注低黏度湿沙期聚甲基丙烯酸甲酯(polymethyl methacrylate,PMMA)骨水泥)和对照组(103例,术中推注低黏度拉丝期PMMA骨水泥)。两组患者性别、年龄、病程、体质量指数、骨密度T值、骨折椎体、责任椎术前骨折严重程度、责任椎前缘高度比值及术前疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)等一般资料比较差异均无统计学意义(P>0.05)。术后即刻、2 d、3个月及末次随访时采用VAS评分及ODI评分评估患者症状改善情况。术后1 d、3个月及末次随访时复查脊柱X线片及CT,观察椎体内骨水泥分布、骨水泥渗漏及其他并发症发生情况;随访期间记录责任椎再骨折率及邻近椎体骨折率。结果观察组骨水泥注入量为(4.53±0.45)mL,与对照组(4.49±0.57)mL比较差异无统计学意义(t=1.018,P=0.310)。两组患者均获随访,随访时间6~18个月,平均13.3个月。观察组共95例(81.9%)骨水泥分布范围大于椎体横断面积49%,对照组72例(69.9%),两组比较差异有统计学意义(χ^2=4.334,P=0.037)。两组患者术后各时间点VAS评分及ODI评分均较术前明显改善(P<0.05);术后各时间点间差异亦有统计学意义(P<0.05)。术后即刻、2 d及3个月观察组VAS评分及ODI评分显著优于对照组(P<0.05);末次随访时两组间VAS评分及ODI评分比较差异无统计学意义(P>0.05)。术后1 d观察组18例发生骨水泥渗漏(静脉渗漏8例、椎旁渗漏6例、椎间盘渗漏4例),对照组22例发生骨水泥渗漏(静脉渗漏9例、椎旁渗漏8例、椎间盘渗漏5例),两组各种骨水泥渗漏发生情况比较�Objective To compare the effect of percutaneous kyphoplasty(PKP)with different phases bone cement for treatment of osteoporotic vertebral compression fracture(OVCF).Methods The clinical data of 219 OVCF patients who treated with PKP and met the selection criteria between June 2016 and May 2018 were retrospectively analyzed.According to the different time of intraoperative injection of bone cement,they were divided into observation group[116 cases,intraoperative injection of polymethyl methacrylate(PMMA)bone cement in low-viscosity wet-sand phase)]and control group(103 cases,intraoperative injection of PMMA bone cement in low-viscosity wire-drawing phase).There was no significance in general date of gender,age,disease duration,body mass index,bone mineral density T value,fracture vertebral body,preoperative fracture severity of the responsible vertebral body,anterior height ratio of the responsible vertebral body,preoperative pain visual analogue scale(VAS)score,and Oswestry disability index(ODI)between the two groups(P>0.05).The VAS score and ODI score were used to evaluate the improvement of patients’symptoms at immediate,2 days,3 months after operation and at last follow-up.At 1 day,3 months after operation,and at last follow-up,X-ray film and CT of spine were reexamined to observe the distribution of bone cement in the vertebral body,bone cement leakage,and other complications.During the follow-up,the refracture rate of the responsible vertebral body and the fracture rate of the adjacent vertebral body were recorded.Results The injection amount of bone cement in the observation group and control group were(4.53±0.45)mL and(4.49±0.57)mL,respectively,showing no significant difference between the two groups(t=1.018,P=0.310).Patients in both groups were followed up 6-18 months(mean,13.3 months).There were 95 cases(81.9%)and 72 cases(69.9%)of the bone cement distribution range more than 49%of the cross-sectional area of the vertebral body in the observation group and the control group,respectively,showing signi

关 键 词：经皮椎体后凸成形术 骨质疏松性椎体压缩性骨折 低黏度湿沙期骨水泥 低黏度拉丝期骨水泥 再骨折 

分 类 号：R687.3[医药卫生—骨科学]