骨水泥弥散分布方式如何影响经皮椎体成形后的早期疗效  

How does bone cement dispersion affect the early outcome of percutaneous vertebroplasty

作　　者：冯冠成 方剑明 吕浩然[1] 张东升 韦家冬 俞兵兵 Feng Guancheng;Fang Jianming;LüHaoran;Zhang Dongsheng;Wei Jiadong;Yu Bingbing(Department of Orthopedics,the Fifth Affiliated Hospital of Guangzhou Medical University,Guangzhou 510700,Guangdong Province,China)

机构地区：[1]广州医科大学附属第五医院骨科,广东省广州市510700

出　　处：《中国组织工程研究》2021年第22期3450-3457,共8页Chinese Journal of Tissue Engineering Research

基　　金：广东省科技计划项目(2017A090905038),项目负责人:吕浩然。

摘　　要：背景:经皮椎体成形治疗骨质疏松性椎体压缩骨折能够即刻稳定椎体,有效缓解疼痛,提高患者生活质量,但骨水泥弥散分布方式与其疗效的关系尚存在争议。目的:分析不同类型骨水泥弥散分布方式对经皮椎体成形后早期疗效的影响。方法:选择2018年1月至2019年12月广州医科大学附属第五医院收治的单椎体骨质疏松性椎体压缩骨折患者155例,接受经皮椎体成形后参照X射线片判断骨水泥分布,分为骨水泥分离组(n=77,其中胸椎骨折22例,腰椎骨折55例)与骨水泥融合组(n=78,其中胸椎骨折39例,腰椎骨折39例)。术前、术后2 d及末次随访时,比较两组间骨水泥渗漏、目测类比评分、Oswestry功能障碍指数评分、椎体高度恢复及局部后凸Cobb角改变量,同时对比两组组内胸椎骨折与腰椎骨折的上述指标差异。结果与结论:①骨水泥分离组、骨水泥融合组术后的目测类比评分、Oswestry功能障碍指数评分低于术前(P<0.05),骨水泥分离组末次随访的目测类比评分低于骨水泥融合组(P<0.05);两组术后的伤椎前缘与中线相对高度高于术前(P<0.05),局部后凸Cobb角低于术前(P<0.05),两组间术后伤椎前缘与中线相对高度改变量、局部后凸Cobb角改变量比较差异无显著性意义(P>0.05);②在骨水泥分离分布类型下,胸椎骨折组术后2 d及末次随访的伤椎前缘高度恢复量低于腰椎骨折组(P<0.05),术后2 d的目测类比评分低于腰椎骨折组(P<0.05);两组间伤椎中线相对高度改变量、局部后凸Cobb角改变量比较差异无显著性意义(P>0.05);③在骨水泥融合分布类型下,胸椎骨折组末次随访的目测类比评分高于腰椎骨折组(P<0.05),两组间伤椎前缘与中线相对高度改变量、局部后凸Cobb角改变量比较差异无显著性意义(P>0.05);④结果表明,两种骨水泥弥散分布方式均可获得满意的术后早期疗效。BACKGROUND:Percutaneous vertebroplasty for osteoporotic vertebral compression fractures can stabilize the vertebral body immediately,relieve pain effectively,and improve the quality of life of patients.However,the relationship between the dispersion pattern of bone cement and its curative effect is still controversial.OBJECTIVE:To analyze the influence of different types of bone cement dispersion distribution on the early curative effect after percutaneous vertebroplasty.METHODS:155 patients with osteoporotic vertebral compression fracture of single vertebral body were selected from January 2018 to December 2019.The distribution of bone cement was determined by X-ray after percutaneous vertebroplasty.The patients were divided into two groups:bone cement separation group(n=77,22 cases of thoracic vertebra fracture and 55 cases of lumbar vertebra fracture)and bone cement fusion group(n=78,39 cases of thoracic vertebra fracture and 39 cases of lumbar vertebra fracture).At the time of preoperatively,2 days postoperatively and final follow-up,bone cement leakage,visual analogue scale score,Oswestry dysfunction index score,vertebral height recovery,and local kyphosis Cobb angle change were compared between the two groups.Simultaneously,the differences in above indexes between thoracic fracture and lumbar fracture were compared between the two groups.RESULTS AND CONCLUSION:(1)The visual analogue scale score and Oswestry dysfunction index of the bone cement separation group and the bone cement fusion group were lower after surgery than those before surgery(P<0.05).The visual analogue scale score of the bone cement separation group was lower than that of the bone cement fusion group during final follow-up(P<0.05).The relative height of anterior edge and midline of the injured vertebra was higher after surgery than that before surgery(P<0.05),and the local kyphotic Cobb angle was lower than that before surgery(P<0.05).There was no significant difference between the two groups in the changes of anterior and midline relative

关 键 词：骨 材料 骨水泥 骨质疏松 椎体压缩骨折 椎体成形 弥散分布 椎体高度 

分 类 号：R459.9[医药卫生—治疗学] R318.08[医药卫生—临床医学]