低温与常温灌注椎体成形术治疗Kümmell病  

Low-temperature versus normal-temperature bone cement perfusion in percutaneous vertebroplasty for Kümmell's disease

作　　者：冯骁骁 吕南宁 张浩[2] 刘昊军 刘明明 FENG Xiao-xiao;LV Nan-ning;ZHANG Hao;LIU Hao-jun;LIU Ming-ming(Bengbu Medical College,Bengbu 233000,China;The Second People's Hospital of Lianyungang City,Clinical College,Bengbu Medical College,Lianyungang 222000,China)

机构地区：[1]蚌埠医学院,安徽蚌埠233000 [2]蚌埠医学院连云港市第二人民医院临床学院,江苏连云港222000

出　　处：《中国矫形外科杂志》2023年第11期980-985,共6页Orthopedic Journal of China

基　　金：江苏省重点研发计划社会发展面上项目(编号:BE2021679);连云港市第六期“521高层次人才培养工程”科研项目(编号:LYG06521202159);连云港市第二人民医院医疗技术创新基金{连二医2020[169号](编号:202004)}。

摘　　要：[目的]比较低温与常温间断灌注经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗Kümmell病的临床疗效。[方法]回顾性分析2018年9月—2021年8月在本科应用PVP治疗的60例Kümmell病患者的临床资料,其中30例采用低温间断灌注组,另外30例采用常温灌注。比较两组患者的围手术期、随访和影像资料。[结果]两组患者均顺利完成手术,低温组的骨水泥可推注时间显著长于常温组[(10.5±1.3)mm vs(4.9±1.0)min,P<0.05],且前者骨水泥渗漏率显著低于后者(6.7%vs36.7%,P<0.05),两组间手术时间、术中透视次数、骨水泥注射量、下地行走时间、住院时间的差异均无统计学意义(P>0.05)。两组患者均获随访(15.0±1.8)个月,两组恢复完全负重活动时间的差异无统计学意义(P>0.05)。与术前相比,两组患者出院及末次随访时,VAS、ODI和JOA评分均显著改善(P<0.05)。术前两组上述指标的差异均无统计学意义(P<0.05),在出院时[VAS(2.0±1.3)vs(2.9±1.3),P=0.010;ODI(27.7±3.5)vs(28.1±3.8),P=0.022;JOA(22.9±2.0)vs(21.7±1.7),P=0.010]和末次随访时[VAS(2.1±1.2)vs(2.9±1.4),P=0.016;ODI(26.5±2.6)vs(27.7±3.7),P=0.034;JOA(22.5±1.5)vs(21.4±1.8),P=0.033]低温组均显著优于常温组。影像方面,低温组的骨水泥弥散优良率显著高于常温组(56.7%vs 30.0%,P<0.05)。与术前相比,术后即刻及末次随访时,两组患椎前缘相对高度、局部Cobb角均显著改善(P<0.05),相应时间点,两组间患椎前缘相对高度与局部Cobb角的差异均无统计学意义(P>0.05)。[结论]骨水泥低温间断灌注显著增加骨水泥有效推注时间,提高骨水泥在椎体中的弥散程度,降低骨水泥渗漏率。[Objective]To compare the clinical efficacy of low-temperature(LT)versus normal-temperature(NT)bone cement perfu-sion in percutaneous vertebroplasty(PVP)for Kümmell's disease.[Methods]A retrospective study was done on 60 patients who underwent PVP for Kümmell's disease in our department from September 2018 to August 2021.Of them,30 patients received LT intermittent perfusion of bone cement,while the remaining 30 patients had PVP performed with bone cement injection under NT.The perioperative period,follow-up and imaging data of the two groups were compared.[Results]All the patients in both groups had PVP performed smoothly.The LT group got significantly longer injectable time of bone cement than the NT group[(10.5±1.3)mm us(4.9±1.0)min,P<0.05],while the former had sig-nificantly lower leakage rate of bone cement than the latter(6.7%us 36.7%,P<0.05),nevertheless there were no significant differences in op-eration time,intraoperative fluoroscopy times,bone cement injection amount,postoperative walking time and hospital stay between the two groups(P>0.05).All of them in both groups were followed up for(15.0±1.8)months on a mean,and there was no significant difference in the time to return to full weight-bearing activities between the two groups(P>0.05).Compared with those preoperatively,the VAS,ODI and JOA scores significantly improved in both groups at discharge and the latest follow-up(P<0.05).Although there was no significant difference in the abovesaid scores between the two groups before surgery(P>0.05),the LT group proved significantly superior to the NT group at discharge[VAS(2.0±1.3)vs(2.9±1.3),P=0.010;0DI(27.7±3.5)vs(28.1±3.8),P=0.022;J0A(22.9±2.0)vs(21.7±1.7),P=0.010]and at the latest fol-low-up[VAS(2.1±1.2)vs(2.9±1.4),P=0.016;0DI(26.5±2.6)vs(27.7±3.7),P=0.034;JOA(22.5±1.5)us(21.4±1.8),P=0.033].Radiographically,the LT group was significantly superior to the NT group in term of satisfactory ratio of bone cement diffusion(56.7% vs 30.0%,P<0.05).Compared with those preoperatively,the relative

关 键 词：Kümmell病 经皮椎体成型术 骨水泥 低温间断灌注 骨水泥渗漏 

分 类 号：R681.57[医药卫生—骨科学]