高粘度骨水泥经皮椎体成形术治疗骨质疏松性椎体压缩骨折的疗效分析

Efficacy analysis of percutaneous vertebroplasty with high-viscosity bone cement for the treatment of osteoporotic vertebral compression fractures

中文关键词:  骨质疏松性椎体压缩骨折  高粘度骨水泥  经皮椎体成形术  经皮椎体后凸成形术

英文关键词:Osteoporotic vertebral compression fracture  High-viscosity bone cement  Percutaneous vertebroplasty  Percutaneous kyphoplasty

中文摘要:

  【摘要】 目的：比较高粘度骨水泥经皮椎体成形术（PVP）与低粘度骨水泥经皮椎体后凸成形术（PKP）治疗骨质疏松性椎体压缩骨折（OVCF）的临床疗效及影像学特征，评价高粘度骨水泥PVP治疗OVCFs的临床价值。方法： 2015年6月~2016年12月我院收治单节段骨质疏松性椎体压缩骨折患者115例，其中65例行高粘度骨水泥PVP（A组），50例行低粘度骨水泥PKP（B组），两组患者年龄、性别、体重指数（BMI）、骨密度（BMD）均无统计学差异。统计两组患者的手术时间、术中透视次数、骨水泥用量、骨水泥渗漏、骨水泥弥散分布情况、伤椎椎体前缘高度和椎体后凸角（Cobb角）、术前和术后VAS评分及ODI等资料，应用SPSS 20.0进行统计学分析。结果：两组患者术后VAS评分、ODI、伤椎椎体前缘高度及Cobb角均较术前显著性改善（P＜0.01）；两组间骨水泥渗漏率无显著性差异；A组手术时间、术中透视次数均显著性少于B组（P＜0.05）。A组骨水泥单侧弥散分布、双侧不对称分布、双侧对称分布分别为6例（9.2%）、12例（18.5%）、47例（72.3%），未弥散至终板、单侧终板弥散、双侧终板弥散分别为3例（4.6%）、16例（24.6%）、46例（70.8%）；B组骨水泥单侧弥散分布、双侧不对称分布、双侧对称分布分别为33例（66.0%）、7例（14.0%）、10例（20.0%），未弥散至终板、单侧终板弥散、双侧终板弥散分别为17例（34.0%）、22例（44.0%）、11例（22.0%），两组间比较有显著性差异（P＜0.01）。结论：高粘度骨水泥PVP治疗OVCF可获得良好的短期临床疗效，骨水泥可对称地弥散至椎体前柱两侧以及椎体上下终板，使伤椎均衡强化，有利于减少手术椎体再骨折风险，骨水泥渗漏风险与低粘度骨水泥PKP相当。

英文摘要:

  【Abstract】 Objectives: To compare the clinical efficacy and imaging characteristics of percutaneous vertebroplasty(PVP) with high-viscosity bone cement and percutaneous kyphoplasty with low-viscosity bone cement for osteoporotic vertebral compression fractures(OVCF), and to estimate the clinical value of PVP with high-viscosity bone cement. Methods: 115 patients were diagnosed and treated with one-level OVCF in Peking University Shougang Hospital from June 2015 to December 2016. 65 patients were applied by PVP with high-viscosity bone cement(group A), and 50 patients were applied by percutaneous kyphoplasty(PKP) with low-viscosity bone cement(group B). The basic clinical information, VAS, ODI, operation time, intraoperative X-ray times, bone cement volume, bone cement leakage, bone cement distribution status, anterior vertebral height and kyphosis(Cobb angle) were collected. SPSS 20.0 was used for statistical analysis. Results: There were significant improvements of VAS, ODI, anterior vertebral height and Cobb angle from preoperatively to postoperatively(P<0.01), there was no significant difference of bone cement leakage between two groups, but the operation time and intraoperative fluoroscopy times of group A were significantly less than those of group B(P<0.01). In group A, there were 6 cases(9.2%) of unilateral diffusion of bone cement in CT, 12 cases(18.5%) of bilateral asymmetric diffusion, 47 cases(73.3%) of bilateral symmetrical diffusion; those three diffusion patterns of group B were 33 cases(66.0%), 7 cases(14.0%), 10 cases(20.0%), respectively; there was a significant difference between the two groups(P<0.01). In group A, there were 3 cases(4.6%) of no endplate diffusion, 16 cases(24.6%) of one endplate diffusion and 46 cases(71.0%) of both endplates diffusion; those of group B were 17 cases(34.0%), 22 cases(44.0%), 11 cases(22.0%), respectively; there was a significant difference between the two groups(P<0.01). Conclusions: PVP with high-viscosity bone cement has a good short-term clinical efficacy. It leads to bone cement symmetrical diffusion to the vertebral anterior column and vertebral endplates, which restores the height of vertebral body, improves the kyphosis and reduces the risk of refracture. But the risk of bone cement leakage of this procedure is comparable to that of PKP with low viscosity bone cement.