骨水泥倒U型分布对经皮椎体成形术治疗骨质疏松椎体压缩性骨折效果的影响

目的探讨经皮椎体成形术(percutaneous vertebroplasty,PVP)中骨水泥倒U型注射分布对治疗骨质疏松性椎体压缩性骨折(osteoporosis vertebral compression fracture,OVCF)临床治疗效果的影响.方法回顾性研究2014年7月至2018年6月因住院并行PVP治疗的70例患者,男性10例,女性60例;年龄60~87岁,平均年龄(73.02±7.74)岁;病程3h^2个月,平均病程(15.35±5.45)d.根据CT检查明确骨水泥的分布情况,依次将患者分为骨水泥呈"倒U型"弥散分布组和骨水泥不规则弥散组.记录术前、术后3 d,3、6个月及1年时的疼痛视觉模拟评分(visual analogue scale,VAS)、椎体高度(body height,BH)及局部后凸Cobb角,对比分析两组上述指标的差异,并记录相关并发症.结果两组患者术前基线特征比较差异无统计学意义(P>0.05),术后VAS较术前均明显降低(P<0.05),倒U型分布组由术前的(7.4±0.8)分降低至术后第3天的(2.5±0.6)分,不规则分布组由(7.5±0.9)分降低至(2.7±0.6)分,但组间比较差异无统计学意义(P>0.05).两组患者术前椎体后凸角度(kyphosis angle,KA)、椎体缘高度(anterior body heights,ABH)和椎体中间高度(middle body heights,MBH)比较,差异无统计学意义(P>0.05),术后倒U型分布组均优于不规则分布组(P<0.05).术后并发症方面,倒U型分布组出现8例骨水泥渗漏,不规则分布组出现5例骨水泥渗漏,总体渗漏率为28.9%,所有骨水泥渗漏均无临床症状.继发相邻椎体骨折倒U型分布组4例,不规则分布组6例;非相邻节段骨折倒U型分布组2例,不规则分布组3例.两组间邻近节段骨折发生率比较,差异无统计学意义(P>0.05).术后1年随访倒U型分布组1例出现骨折椎体再次塌陷,再骨折率为3.1%;不规则分布组5例出现骨折椎体再次塌陷,再骨折率为14.3%.结论PVP可有效缓解胸腰段OVCF患者的疼痛,骨水泥在椎体内弥散分布情况对术后近期治疗效果无明显影响,但可能是PVP术后患椎再骨折的重要影响因素.

Effect of inverted U-shaped distribution of bone cement on the percutaneous vertebroplasty in the treatment of osteoporosis vertebral compression fracture

Objective To investigate the effects of the distribution of inverted U-type bone cement injection in percutaneous vertebroplasty(PVP)on the treatment of osteoporosis vertebral compression fracture(OVCF).Methods Seventy patients were analyzed retrospectively in this study,who were diagnosed as thoracolumbar OVCF and treated by PVP from July 2014 to June 2018.There were 10 males and 60 females,with a mean age of(73.02±7.74)years(60-87)years,the average duration of(15.35±5.45)d(3 h-2 months).The distribution of bone cement in the vertebral body was determined based on CT.Patients were allocated to U-shaped group(n=37):bone cement was“inverted U-shaped”diffuse distribution,and irregular group(n=33):bone cement was irregular dispersed.Visual analyogue scale(VAS),body heights and local kyphotic Cobb angle at pre-operation,3 days,6 months,1 year after the operation as well as the complication were compared between two groups.Results PVP were performed successfully in all patients without severe complication.The baseline characters showed no significant difference between two groups.U-shaped group decreased from 7 4±0.8 before surgery to 2 5±0.6 on the third day after surgery,and irregular group decreased from(7.5±0.9)to(2.7±0.6),but there was no significant difference between the groups(P>0.05).There was no significant difference between the two groups in preoperative KA,ABH,and MBH(P>0.05).U-shaped group was superior to irregular group(P<0.05)after operation.Eight cases in U-shaped group and 5 cases in irregular group presented asymptomatic bone cement leakage respectively,with a total leakage rate of 28.9%.Conclusions PVP is an effective therapy for thoracolumbar OVCF due to its pain relief.The distribution of bone cement in vertebral body has no significant effects on the short-term curative effect,but it may be an important factor in the treatment of vertebral refracture after PVP.