不同骨水泥类型在多发性骨髓瘤椎体压缩性骨折患者椎体后凸成形术中的应用价值  

Application Value of Different Types of Bone Cement in Kyphoplasty of Patients with Multiple Myeloma Vertebral Compression Fracture

作　　者：陈超[1] 刘永刚[1] 李慧峰 田冬冬 付宇挺 左立新[1] CHEN Chao;LIU Yong-gang;LI Hui-feng;TIAN Dong-dong;FU Yu-ting;ZUO Li-xin(Department of Orthopedics,The People's Hospital of Anyang City,Anyang 455000,Henan Province,China)

机构地区：[1]安阳市人民医院骨三科,河南安阳455000

出　　处：《罕少疾病杂志》2024年第9期108-110,共3页Journal of Rare and Uncommon Diseases

基　　金：2020年度河南省医学科技攻关计划项目(LHGJ20200798)。

摘　　要：目的 对比不同骨水泥类型下行椎体后凸成形术(PKP)治疗多发性骨髓瘤(MM)椎体压缩性骨折(VCF)患者的效果。方法 选取我院86例MM VCF患者(2020年5月~2023年2月),随机分为2组,各43例。2组均接受PKP治疗,其中A组术中应用高黏度骨水泥,B组术中应用低黏度骨水泥。对比2组围术期指标、骨水泥渗漏、手术前后Oswestry功能障碍指数、疼痛数字评分(NRS)、影像学指标[Cobb角、伤椎前缘高度(AVH)]、骨代谢[β-胶原降解产物(β-CTX)、骨γ-梭基谷氨酸蛋白(BGP)、骨形态发生蛋白-2(BMP-2)]水平。结果 2组手术用时、骨水泥注入量、术中失血量相比,无明显差异(P>0.05);与B组骨水泥总渗漏率23.26%(10/43)相比,A组4.65%(2/43)较更低(P<0.05);术后3个月A组ODI、NRS评分与B组相比更低(P<0.05);术后3个月A组Cobb角与B组相比更低,AVH与B组相比更高(P<0.05);术后3个月A组血清β-CTX水平与B组相比更低,血清BGP、BMP-2水平与B组相比更高(P<0.05)。结论 相较于低黏度骨水泥,MM VCF患者行PKP术治疗时,应用高黏度骨水泥注入更有助于减少骨水泥渗漏,恢复伤椎AVH、Cobb角,改善椎体功能及机体骨代谢水平,维持椎体稳定性,减轻疼痛感。Objective To compare the effects of different types of bone cement descending kyphoplasty(PKP)in the treatment of multiple myeloma(MM)with vertebral compression fracture(VCF).Methods 86 patients with MM VCF in our hospital(May 2020~February 2023)were randomly divided into 2 groups with 43 cases in each group.The two groups received PKP treatment,in which group A was treated with high viscosity bone cement,group B was treated with low viscosity bone cement.Perioperative indexes,bone cement leakage,Oswestry disability index before and after surgery,numerical pain score(NRS),imaging indexes[Cobb Angle,anterior vertebra height(AVH)],bone metabolism[β-collagen degradation products(β-CTX),boneγ-fobyl glutamate protein(BGP),bone morphogenetic protein-2(BM)were compared between the two groups P-2]level.Results There were no significant differences in operation time,bone cement injection amount and intraoperative blood loss between the two groups(P>0.05).The total leakage rate of bone cement in group A was 4.65%(2/43)lower than 23.26%(10/43)in group B(P<0.05).ODI and NRS scores in group A were lower than those in group B 3 months after operation(P<0.05).The Cobb Angle of group A was lower than that of group B,and the AVH was higher than that of group B at 3 months after operation(P<0.05).The serumβ-CTX level of group A was lower than that of group B,and the serum BGP and BMP-2 levels were higher than that of group B 3 months after surgery(P<0.05).Conclusion Compared with low-viscosity bone cement,when MM VCF patients are treated with PKP,the application of high-viscosity bone cement injection is more helpful to reduce bone cement leakage,restore AVH and Cobb Angle of injured vertebra,improve vertebral function and bone metabolism level,maintain vertebral stability,and alleviate pain.

关 键 词：多发性骨髓瘤 骨代谢 椎体压缩性骨折 骨水泥渗漏 

分 类 号：R733.3[医药卫生—肿瘤]