高粘度与低粘度骨水泥PVP治疗骨质疏松椎体压缩骨折的疗效和并发症

The outcomes and complications of high-viscosity and low-viscosity bone cement in percutaneous vertebroplasty for treatment of osteoporotic vertebral compression fractures

中文关键词:  椎体成形术  骨水泥渗漏  椎体骨折  骨质疏松  骨水泥

英文关键词:Vertebroplasty  Cement leakage  Vertebral fracture  Osteoporosis  Bone cement

中文摘要:

  【摘要】 目的：比较经皮椎体成形术（PVP）中使用高粘度PMMA骨水泥和低粘度PMMA骨水泥治疗骨质疏松椎体压缩骨折的疗效和并发症发生率。方法：2008年9月~2011年2月对行PVP治疗的60例骨质疏松性椎体压缩骨折患者进行前瞻性随机对照研究。将患者随机化分为高粘度组（PVP使用高粘度PMMA骨水泥，30例）和低粘度组（PVP使用低粘度PMMA骨水泥，30例）。高粘度组采用PALACOS R+G高粘度PMMA骨水泥，低粘度组采用MENDEC Spine低粘度PMMA骨水泥。两组患者年龄、性别比、体重指数（BMI）及手术节段差异无统计学意义（P>0.05）。采用视觉模拟量表（VAS）进行疼痛评分，采用Oswestry功能障碍指数（ODI）进行腰椎功能评分，观察并比较两组患者的VAS评分、ODI，骨水泥静脉渗漏、椎间盘渗漏、椎旁渗漏及邻近椎体骨折等发生情况。结果：60例患者均获随访，其中高粘度组随访时间2～5年，平均3.7±0.9年；低粘度组随访时间2～5年，平均3.7±1.0年，两组平均随访时间无统计学差异（P>0.05）。高粘度组VAS评分由术前8.4±1.4分降低到末次随访时0.5±0.7分，ODI由术前（59.7± 18.0）%降低到末次随访时（8.1±5.6）%；低粘度组VAS评分由术前8.3±1.5分降低到末次随访时0.9±0.9分，ODI由术前（67.7±12.5）%降低到末次随访时（8.7±7.6）%（P<0.05）；两组末次随访时腰痛VAS评分及ODI均较术前明显改善（P<0.05），末次随访时腰痛VAS评分及ODI两组比较均无统计学差异（P>0.05）。高粘度组骨水泥静脉渗漏率明显低于低粘度组（8.2% vs. 41.3%，P<0.05）；高粘度组骨水泥椎间盘渗漏率、椎旁渗漏率和邻近椎体骨折发生率分别为6.1%、8.2%和6.6%；低粘度组分别为13.0%、12.0%和3.3%，两组间比较均无统计学差异（P>0.05）。结论：PVP术中使用高粘度骨水泥和低粘度骨水泥治疗骨质疏松椎体压缩性骨折具有相似的治疗效果、椎间盘渗漏率、椎旁渗漏率和邻近椎体骨折发生率，但高粘度骨水泥能显著降低骨水泥静脉渗漏率。

英文摘要:

  【Abstract】 Objectives: To compare the clinical outcomes and complications of high-viscosity and low-viscosity bone cement in percutaneous vertebroplasty(PVP) for osteoporotic vertebral compression fractures(OVCF). Methods： From September 2008 to February 2011, 60 patients with OVCF were enrolled in this study. The patients were randomized into the high-viscosity group(high-viscosity bone cement, 30 patients) and the low-viscosity group(low-viscosity bone cement, 30 patients). High-viscosity group used the PALACOS R+G high-viscosity PMMA, low-viscosity group used the MENDEC Spine low-viscosity PMMA. There was no significant difference in age, gender, BMI or the number of segments between the two groups(P>0.05). Clinical outcomes were assessed in terms of back pain visual analogue scale(VAS) and Oswestry disability index(ODI) after surgery. The outcomes of back pain VAS score, ODI, venous leakage rate, discoidal leak rate, rate of around vertebral body, rate of contiguous vertebral fracture were compared between two groups. Results： The mean follow-up in high and low-viscosity group was 3.7±0.9(range 2-5 years) and 3.7±1.0 years(range 2-5 years), respectively. There was no significantly different in the mean follow-up in both groups(P>0.05). The average VAS score and ODI improved significantly at final follow-up(P<0.05), from 8.4±1.4 to 0.5±0.7 and from (59.7±18.0)% to (8.1±5.6)% in low and high-viscosity group respectively. The average VAS score and ODI scale improved significantly at final follow-up(P<0.05), from 8.3±1.5 to 0.9±0.9 and from (67.7±12.5)% to (8.7±7.6)% in high and low-viscosity group respectively. At final follow-up, there was no significant difference in VAS or ODI in both groups(P>0.05). The venous leakage rate in the high-viscosity group was significantly lower than that in the low-viscosity group(8.2% vs.1.3%, P<0.05). The discoidal leak rate, paravertebral leak rate and rate of contiguous vertebral fracture in the high-viscosity group was 6.1%, 8.2% and 6.6%, respectively, while in the low-viscosity group it was 13.0%, 12.0% and 3.3%, respectively. There was no significant difference in discoidal leak rate, paravertebral leak rate or rate of contiguous vertebral fracture in both groups(P>0.05). Conclusions: The high-viscosity bone cement in PVP for osteoporotic vertebral fractures provides similar outcomes, discoidal leak rate, paravertebral leak rate and rate of contiguous vertebra fracture to low-viscosity bone cement, with a lower venous leakage rate.