自固化磷酸钙人工骨与PMMA骨水泥联合经皮椎体成形术治疗骨质疏松性椎体压缩性骨折的疗效分析  

Clinical efficacy of self-curing calcium phosphate bone cement(CPC)mixed with PMMA bone cement in the treatment of osteoporotic vertebral compression fractures by percutaneous vertebroplasty

作　　者：李建伟 齐新生 林庆玺 孙永 崔亚珍 Li Jianwei;Qi Xinsheng;Lin Qingxi;Sun Yong;Cui Yazhen(Department of Orthopedics,Taikang Xianlin Gulou Hospital Affiliated to Nanjing University School of Medicine,Nanjing 210023,China)

机构地区：[1]南京大学医学院附属泰康仙林鼓楼医院骨科,南京210023

出　　处：《创伤外科杂志》2024年第9期668-674,共7页Journal of Traumatic Surgery

摘　　要：目的探讨经皮椎体成形术(PVP)联合自固化磷酸钙人工骨(CPC)混合聚甲基丙烯酸甲酯(PMMA)骨水泥治疗骨质疏松性椎体压缩性骨折(OVCF)的疗效,并分析术后并发症。方法回顾性分析2020年10月—2023年10月南京大学医学院附属泰康仙林鼓楼医院骨科行PVP治疗的111例OVCF患者临床资料,其中男性20例,女性91例;年龄52~86岁,平均67.8岁;跌倒伤68例,道路交通伤31例,其他12例。按照填充物的不同分为PMMA组(PMMA骨水泥为填充物,53例)和混合组(填充物为CPC与PMMA骨水泥1∶1混合,58例),比较两组患者疼痛、影像学指标、功能障碍、生活质量、治疗有效率和并发症发生率。结果与术前比较,两组术后2 d、1、3、6个月VAS降低(P<0.05);与PMMA组比较,混合组术后2 d、1、3、6个月VAS比较差异无统计学意义(P﹥0.05)。与术前比较,两组术后2 d、1、3、6个月Cobb角、椎体矢状指数比较差异无统计学意义(P﹥0.05);与PMMA组比较,混合组术后2 d、1、3、6个月Cobb角、椎体矢状指数比较差异无统计学意义(P﹥0.05)。两组术后1、3、6个月Oswestry功能障碍指数(ODI,PMMA组:54.62±6.58、38.40±6.11、36.30±6.58,混合组:55.52±6.22、35.57±6.20、32.62±4.22)、国际骨质疏松生活质量评估量表(QUALEFFO-41)评分[PMMA组:(37.58±5.86)分、(35.96±6.26)分、(34.74±5.93)分;混合组:(39.02±5.70)分、(32.66±5.19)分、(31.64±4.98)分]低于术前[ODI:PMMA组75.19±8.97,混合组74.88±9.84;QUALEFFO-41评分:PMMA组(66.30±9.09)分,混合组(65.59±9.01)分],差异有统计学意义(P<0.05),与PMMA组比较,混合组术后3、6个月ODI、QUALEFFO-41评分更低(P<0.05)。PMMA组与混合组治疗有效率(98.1%vs.98.3%)、骨水泥渗漏率(15.1%vs.27.6%)、邻近椎体骨折率(11.3%vs.19.0%)比较差异无统计学意义(P均>0.05)。结论与PVP联合PMMA骨水泥为填充物相比,PVP联合CPC混合PMMA骨水泥治疗OVCF患者,可更有效改善功能障碍,提高生活质量,不会增加并�Objective To explore the clinical effect of self-curing calcium phosphate bone cement(CPC)mixed with polymethylmethacrylate(PMMA)bone cement in percutaneous vertebroplasty(PVP)of osteoporotic vertebral compression fractures(OVCFs),and to analyze the postoperative complications.Methods A retrospective analysis was conducted on clinical data of 111 OVCF patients treated by PVP in the Orthopedics Department of Taikang Xianlin Gulou Hospital Affiliated to Nanjing University School of Medicine from Oct.2020 to Oct.2023,including 20 males and 91 females aged 52-86(mean 67.8)years.There were 68 cases of falls,31 road traffic injuries,and 12 others.According to different fillers,patients were divided into PMMA group(filled with PMMA bone cement,n=53)and mixed group(filled with a mixture of CPC and PMMA bone cement at a 1∶1 ratio,n=58).The pain,imaging indicators,functional impairment,quality of life,and complications were compared between the two groups.Results Compared with before surgery,the VAS of both groups decreased at 2 d,1,3 and 6 months after surgery(P<0.05),but comparison between the two groups revealed no significant difference at all time points(P>0.05).The Cobb angle and sagittal index of the vertebral body at 2 d,1,3 and 6 months after surgery neither revealed any significant differences compared with before surgery nor between the two groups(all P>0.05).However,compared with before surgery,both groups at 1,3 and 6 months after surgery showed significantly reduced Oswestry dysfunction index(ODI,PMMA group:54.62±6.58,38.40±6.11,36.3±6.58 vs.75.19±8.97;Mixed group:55.52±6.22,35.57±6.20,32.62±4.22 vs.74.88±9.84)and Quality of Life Questionnaire of the European Foundation for Osteoporosis-41(QUALEFFO-41)scores(PMMA group:37.58±5.86,35.96±6.26,34.74±5.93 vs.66.30±9.09;Mixed group:39.02±5.70,32.66±5.19,31.64±4.98 vs.65.59±9.01,all P<0.05),moreover,comparison between the two groups showed significantly lower ODI and QUALEFFO-41 scores in the mixed group at 3 and 6 months after surgery(all P<0.05)

关 键 词：骨质疏松性椎体压缩性骨折 经皮椎体成形术 并发症 骨水泥 

分 类 号：R683.2[医药卫生—骨科学]