骨水泥在椎体骨折线内弥散情况对椎体成形术治疗效果的影响

The effect of distribution of bone cement in the fracture lines on the outcome of percutaneous vertebroplasty

中文关键词:  椎体成形术  骨水泥弥散  骨质疏松性椎体压缩骨折  骨折线  后凸畸形

英文关键词:Percutaneous vertebroplasty  Bone cement diffusion  Osteoporosis vertebral compression fracture  Fracture line  Kyphosis

中文摘要:

  【摘要】 目的：探讨经皮椎体成形术（PVP）中骨水泥在椎体骨折线内弥散情况对疗效的影响。方法：回顾性研究2009年9月~2011年12月因骨质疏松性椎体压缩骨折（OVCF）住院并行PVP治疗的45例患者，男14例，女31例，年龄53~88岁，平均72.18岁，病程2h~4个月，平均17.36d。均为胸腰段（T10~L2）单一椎体骨折。根据术前多平面重建CT或MRI评估椎体骨折线位置，参考术后X线、多平面重建CT判断骨水泥在椎体骨折线内的弥散情况，将患者分成两组，A组（n=30）：骨水泥充分弥散在骨折线内，B组（n=15）：骨水泥在骨折线内弥散不佳。记录术前、术后3d及末次随访时的疼痛视觉模拟评分（visual analogue scale，VAS）、Oswestry功能障碍指数（Oswestry disability index，ODI）及局部后凸Cobb角，末次随访时与术后3d局部Cobb角之差定义为后凸纠正丢失量，对比分析两组上述指标的差异，并记录相关并发症。结果：所有患者均顺利完成椎体成形术，无严重并发症出现。除骨密度外两组患者术前基线特征无显著性差异，术后3d及末次随访时的VAS评分、ODI均较术前明显改善（P<0.05），术后3d时的VAS评分、ODI相比术前值的改善程度（术前-术后）A组优于B组（VAS：5.03±1.33 vs 3.53±1.13，ODI：26.17±2.10 vs 24±2.03，P<0.05），末次随访时的VAS评分、ODI两组无显著性差异（P＞0.05）。两组术后3d局部Cobb角均较术前明显纠正（P＜0.05），A组术后3d时的Cobb角与末次随访时无显著性差异（P＞0.05），B组末次随访时的后凸Cobb角较术后3d时显著增大（P＜0.05）。A组后凸纠正丢失量显著小于B组（1.08°±0.38° vs 3.58°±0.37°，P＜0.05）。A组8例出现骨水泥渗漏，B组6例出现骨水泥渗漏，总体渗漏率为31.1%，骨水泥渗漏均未引起临床症状。结论：PVP可有效缓解胸腰段骨OVCF患者的疼痛，改善功能障碍；骨水泥在骨折线内弥散不佳会影响近期疗效，也可能是骨折椎体接受PVP术后仍发生进展性后凸畸形的危险因素。

英文摘要:

  【Abstract】 Objectives: To evaluate the effect of distribution of bone cement in the fracture lines on the outcome of percutaneous vertebroplasty(PVP). Methods: 45 patients were analyzed retrospectively in this study, all cases were diagnosed as thoracolumbar osteoporosis vertebral compressional fracture(OVCF) and treated by PVP(T10-L2) from September 2009 to December 2011. There were 14 males and 31 females, with a mean age of 72.18 years(53-88ys), the average duration was 17.36d(2h-4m). The distritution of vertebral fracture lines was determined based on preoperative CT or MRI. According to the relationship between bone cement and fracture lines in postoperative X-ray or CT, patients were allocated to group A(n=30): bone cement diffusing into fracture line sufficiently, and group B(n=15): bone cement diffusing into fracture line insufficiently or absently. VAS, ODI and local kyphotic Cobb angle at preoperation, 3 days after the operation and the last follow-up as well as the complication were compared between two groups. Results: PVP were performed successfully in all patients without severe complication. The baseline characters except the BMD showed no significant difference between two groups. VAS and ODI scores after operation improved significantly compared with preoperative ones in both groups(P<0.05). Compared with preoperation, VAS and ODI at 3 days after surgery of group A was higher than those of group B(VAS: 5.03±1.33 vs 3.53±1.13, ODI: 26.17±2.10 vs 24±2.03, P<0.05), but there was no significant difference between two groups at the last follow-up(P＞0.05). The local kyphotic Cobb angle at 3 days after operation in two groups decreased significantly compared with preoperative ones(P<0.05). There was no significant difference between 3 days after operation and the last follow-up in group A(P>0.05). However, in group B, the local kyphotic cobb angle at the last follow-up was significantly higher than that at 3 days after surgery(P＜0.05). Loss of correction in group A was significantly lower than that in group B(1.08°±0.38° vs 3.58°±0.37°, P＜0.05). 8 cases in group A and 6 cases in group B presented asymptomatic bone cement leakagerespectively, with a total leakage rate of 31.1%. Conclusions: PVP is an effective therapy for thoracolumbar OVCF due to its pain relief and function recovery. Insufficient bone cement distribution in the fracture lines may affect the short-term clinical outcome, furthermore, it may be a risk factor to induce progressive kyphotic deformity.