两种水泥注入法在胸腰椎骨质疏松性压缩性骨折经皮穿刺椎体成形术中的应用效果比较

Comparison of the application effect of two bone cement injection methods in percutaneous vertebroplasty for thoracolumbar osteoporotic compression fractures

目的比较2种骨水泥注入方式在胸腰椎骨质疏松性压缩性骨折经皮穿刺椎体成形术(percutaneous vertebro plasty,PVP)中的应用效果。方法选取2019年5月至2021年5月古田县医院收治的62例胸腰椎骨质疏松性压缩性骨折患者作为研究对象,按照随机数字表法分为观察组和对照组,每组31例。两组均采用PVP治疗,观察组采用侧开式骨水泥注入方式,对照组采用前开式骨水泥注入方式。比较两组手术相关指标、手术前后椎体情况、手术前后疼痛程度、功能障碍程度及并发症发生情况。结果两组手术时间、术中出血量比较,差异无统计学意义(P>0.05);观察组骨水泥注入量明显高于对照组,差异有统计学意义(P<0.05)。术后6个月,两组椎体压缩率、Cobb角均低于本组术前,伤椎前中柱高度高于术前,差异有统计学意义(P<0.05);两组上述指标比较,差异无统计学意义(P>0.05)。术后7 d,两组视觉模拟评分法(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)评分均低于本组术前,差异有统计学意义(P<0.05);两组上述评分比较,差异无统计学意义(P>0.05)。观察组骨水泥渗漏率明显低于对照组,差异有统计学意义(P<0.05);两组一过性低血压、感染、疼痛加剧发生率比较,差异无统计学意义(P>0.05)。结论骨水泥前开式注入与侧开式注入在胸腰椎骨质疏松性压缩性骨折PVP治疗中均取得满意疗效,但侧开式注入对骨水泥渗漏预防效果更好。

Objective To compare the application effect of two bone cement injection methods in percutaneous vertebroplasty(PVP)for thoracolumbar osteoporotic compression fractures.Methods A total of 62 patients with thoracolumbar osteoporotic compression fractures admitted to Gutian County Hospital from May 2019 to May 2021 were selected as the research objects and divided into observation and control groups according to the random number table method,with 31 cases in each group.Both groups received PVP treatment.The observation group received a lateral opening bone cement injection and the control group received a forward opening bone cement injection.The relevant indicators of surgery,the condition of the vertebral body before and after surgery,the degree of pain before and after surgery,the degree of dysfunction,and the complications were compared between the two groups.Results There were no statistically significant differences between the two groups with respect to operative time and intraoperative blood loss(P>0.05);however,the amount of bone cement injection in the observation group was significantly higher than the control group(P<0.05).The vertebral compression ratios and Cobb angles in the two groups were significantly decreased 6 months postoperatively compared to the preoperative vertebral compression ratios and Cobb angles,and the height of the injured anterior middle column 6 months postoperatively was significantly increased compared with the preoperative height of the injured anterior middle column in both treatment groups(P<0.05).Moreover,the above-mentioned indicators were not significantly different between the two groups(P>0.05).The visual analogue scale(VAS)and Oswestry dysfunction index(ODI)scores were significantly lower in both groups 7 days postoperatively than preoperatively(P<0.05);the indicators were not significantly different between the 2 groups(P>0.05).The bone cement leakage rate in the observation group was significantly lower than the control group(P<0.05).The incidence of transient hypotension,infections,and pain exacerbation between the two groups was not statistically significant(P>0.05).Conclusions Forward and lateral opening bone cement injection achieved satisfactory efficacy in the treatment of PVP for thoracolumbar osteoporotic compression fractures,but lateral injection had a better effect on prevention of bone cement leakage.