椎体成形术中采用高黏度骨水泥治疗胸腰椎重度骨质疏松性椎体压缩性骨折

目的探讨椎体成形术(PVP)中采用高黏度骨水泥治疗胸腰椎重度骨质疏松性椎体压缩性骨折(OVCF)的临床疗效。方法回顾性分析2016年6月—2018年1月采用PVP治疗的43例胸腰椎重度OVCF患者(53个椎体)临床资料。所有患者术中采用高黏度骨水泥,记录手术时间、骨水泥注射量,术中X线透视了解骨水泥椎体内分布情况;比较术前,术后24 h、3个月和6个月疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)及活动功能。结果所有手术顺利完成,手术时间(40.12±12.22)min,骨水泥注入量(3.2±1.6)mL。所有患者随访(9.6±3.2)个月,8例患者9个椎体发生骨水泥渗漏(6个椎体骨水泥渗入相邻椎间盘,2个椎体渗入椎体前,1个椎体渗漏至椎旁软组织),均无明显临床症状,未行特殊治疗。术后24 h、3个月和6个月VAS评分、ODI及活动能力与术前相比均显著改善,差异有统计学意义(P<0.05)。结论PVP术中采用高黏度骨水泥治疗胸腰椎重度OVCF可简化手术步骤,有效缓解疼痛,显著提高术后患者活动能力和生活质量,并发症发生率低,值得临床推广。

Treatment of severe thoracolumbar osteoporotic vertebral compression fractures by vertebroplasty with high-viscosity bone cement

Objective To investigate the clinical effect of vertebroplasty with high-viscosity bone cement in the treatment of severe thoracolumbar osteoporotic vertebral compression fracture(OVCF). Methods The clinical data of 43 patients (53 vertebrae) with severe thoracolumbar OVCF treated with PVP from June 2016 to January 2018 were retrospectively analyzed. All the patients were treated with high-viscosity bone cement. The operation time and the injection amount of bone cement were recorded. The distribution of bone cement in vertebral body was observed by X-ray fluoroscopy during the operation. The visual analogue scale (VAS), Oswestry disability index (ODI) and activity function before and 24 h, 3 months and 6 months after operation were compared. Results All the operations were successfully completed. The operation time was(40.12±12.22) min, and the amount of bone cement injected was (3.2±1.6) mL. All the patients were followed up for (9.6±3.2) months. Nine vertebrae(8 cases) had cement leakage(6 into adjacent intervertebral discs, 2 into anterior vertebral bodies and 1 in to paravertebral soft tissue) without obvious clinical symptoms and no special treatment. The VAS score, ODI and activity ability at postoperative 24 h, 3 months and 6 months were significantly improved compared with those at pre-operation, all with statistical significances (P<0.05). Conclusion The use of high-viscosity bone cement in the treatment of severe thoracolumbar OVCF during PVP can simplify the surgical procedures, effectively relieve pain, significantly improve the postoperative activity ability and quality of life of patients, and the incidence of complications is low, thus being worthy of clinical promotion.