高粘度骨水泥椎体成形术治疗骨质疏松性椎体压缩骨折的椎体高度恢复情况及相关影响因素

Vertebral height restoration and its associative factors during high-viscosity bone cement vertebroplasty in the treatment of osteopomsis vertebral compression fractures

中文关键词:  骨质疏松性椎体压缩骨折  椎体成形术  骨水泥  相关性

英文关键词:Osteopomsis vertebral compression fracture  Vertebroplasty  Bone cement  Correlation

中文摘要:

  【摘要】 目的：分析应用高粘度骨水泥行椎体成形术治疗骨质疏松性椎体压缩骨折（OVCF）的椎体高度恢复效果及其与骨水泥注入量、弥散程度的相关性。方法：2015年1月~2016年12月我院采用高粘度骨水泥椎体成形术治疗96例OVCF患者，其中男44例，女52例；年龄56~79岁（67.36±5.36岁）；117个病椎，其中胸椎41个，腰椎76个；单节段47例，双节段49例。按照其骨水泥注入量的不同分组，注入量≤4ml为A1组（n=41），注入量>4ml为A2组（n=55）；按照其骨水泥弥散程度的不同分组，填充率≤15%为B1组（n=37），填充率>15%为B2组（n=59）。对比各组术前、术后7d骨折椎体的椎体前缘、中央高度情况，并采用直线回归分析骨折椎体前缘高度恢复效果与骨水泥注入量、弥散程度的相关性。结果：A1组术后7d骨折椎体前缘高度高于术前（P<0.05），而椎体中央高度与术前比较无统计学差异（P>0.05）；A2组术后7d骨折椎体前缘、中央高度均明显高于术前（P<0.05），且均高于A1组（P<0.05）。B1组术后7d骨折椎体前缘、中央高度与术前比较均无统计学差异（P>0.05），而B2组术后7d骨折椎体前缘、中央高度均明显高于术前（P<0.05），且均高于B1组（均P<0.05）。骨折椎体前缘高度恢复效果与骨水泥注入量（r=0.63）、弥散程度（r=0.65）均密切相关（P<0.01）。术后3个月随访，A2组骨水泥渗漏发生率为1.82%（1/55），稍低于A1组的4.88%（2/41），但无统计学差异（χ2=0.47，P>0.05）；B2组骨水泥渗漏发生率为1.69%（1/59），稍低于B1组的5.41%（2/37），但无统计学差异（χ2=0.58，P>0.05）。结论：应用高粘度骨水泥并适当提高其注入量与弥散程度行椎体成形术可有效改善OVCF患者的骨折椎体高度，明显增强其骨折椎体的恢复效果。

英文摘要:

  【Abstract】 Objectives: To investigate the vertebral height restoration and its associative factors during high-viscosity bone cement vertebroplasty in the treatment of osteopomsis vertebral compression fractures(OVCF). Methods: 96 cases using high-viscosity bone cement during vertebroplasty were selected in our hospital from January 2015 to December 2016. There were 44 males and 52 females, aged 56-79 years old, with an average age of 67.36±5.36 years. Thoracic vertebrae were involved in 41 cases and lumbar vertebrae in 55 cases; 47 cases had single segment involved and 49 cases had double segments. According to the injection volume of bone cement, those with injection volume ≤4ml were classified as group A1(n=41), injection volume >4ml as group A2(n=55); according to the distribution of bone cement, the cases with filling rate ≤15% was classified as group B1(n=37), filling rate >15% as group B2(n=59). The anterior vertebral heights before operation and at 3 days after operation were compared among the four groups and the correlations of anterior vertebral height restoration with bone cement injection volume and diffusion degree were analyzed by linear regression analysis. Results: The anterior vertebral height at 3 days after operation in group A1 was higher than the preoperative one(P<0.05), and the central vertebral height showed no significant difference compared with the preoperative one(P>0.05); the postoperative anterior vertebral height and central vertebral height in group A2 were significantly higher than the preoperative ones(P<0.05), and those levels of group A2 were higher than those of group A1(P<0.05). The postoperative anterior vertebral height and central vertebral height in the group B1 showed no significant difference compared with the preoperative ones(P>0.05), and the postoperative anterior vertebral height and central vertebral height in group B2 were significantly higher than those before operation(both P<0.05), and those levels of group B2 were higher than those of group B1(P<0.05). The vertebral height restoration was closely related to the bone cement injection volume(r=0.63) and dispersion degree(r=0.65)(P<0.01). After 3 months of follow-up, the incidence rate of bone cement leakage in group A2 accounted for 1.82%(1/55), which was slightly lower than that of group A1 of 4.88%(2/41), but there was no statistical significance(χ2=0.47, P>0.05); the incidence of cement leakage in group B2 was 1.69%(1/59), which was slightly lower than that of group B1 of 5.41%(2/37), which showed no statistically significant difference(χ2=0.58, P>0.05). Conclusions: The high-viscosity bone cement appropriately increases the bone cement injection volume and dispersion degree which can effectively improve the vertebral height in patients with compression fractures.