三种不同填充物在PVP入路治疗胸腰椎OVCF中的应用研究

Study on the application of three different fillers in the treatment of thoracolumbar OVCF by PVP approach

目的探究不同填充物在经皮椎体成形术(PVP)入路治疗胸腰椎单节段骨质疏松性椎体压缩骨折(OVCF)的应用研究。方法前瞻性选取2022年6月至2023年5月在珠海市中西医结合医院接受PVP入路治疗的胸腰椎OVCF患者190例,根据信封法对患者进行分组:对照组(n=65)、研究1组(n=41)、研究2组(n=84)。对照组患者行双侧骨水泥注入,研究1组患者行一侧骨水泥,一侧骨粉注入,研究2组患者行双侧混合骨水泥与骨粉注入,对患者进行6个月的随访。记录患者术前、术后1 d、术后3个月、术后6个月的Oswestry功能障碍指数(ODI)评分、视觉模拟评分法(VAS)评分、Cobb角情况及术前、末次随访时的椎体后凸角度(KA)、椎体前缘高度(ABH)和椎体中间高度(MBH)、骨密度水平,记录患者随访期内并发症发生情况。结果术后1 d、3个月、6个月,3组患者的ODI评分比较,差异均有统计学意义(P<0.05),其中研究1组、研究2组患者的ODI评分均低于对照组,研究2组的ODI评分低于研究1组,差异均有统计学意义(P<0.05)。3组患者术后3、6个月的VAS评分比较,差异均无统计学意义(P>0.05);术后1 d,3组患者VAS评分比较,差异有统计学意义(P<0.05),其中研究1组、研究2组患者的VAS评分低于对照组,研究2组的VAS评分低于研究1组,差异均有统计学意义(P<0.05)。术后1 d、3个月、6个月,3组患者的Cobb角比较,差异均有统计学意义(P<0.05),其中研究1组、研究2组患者的Cobb角小于对照组,研究2组的Cobb角小于研究1组,差异均有统计学意义(P<0.05)。末次随访时,3组KA、ABH、MBH比较,差异均有统计学意义(P<0.05),其中研究1组、研究2组患者的KA低于对照组,ABH、MBH高于对照组,且研究2组的KA低于研究1组,ABH、MBH高于研究1组,差异均有统计学意义(P<0.05)。随访期间,研究2组患者总并发症发生率为3.57%,低于对照组(12.31%)、研究1组(24.39%),差异有统计学意义(P<0.05)。结论在PVP入路治疗胸腰椎OVCF中,相比于单独使用骨水泥和部分使用骨粉,混合骨水泥与骨粉方案能够获得更好的功能恢复和疼痛缓解效果,同时改善椎体角度和骨密度指标,并降低术后并发症和邻椎骨折的风险。

Objective To investigate the application of different fillers in the treatment of single thoracolumbar thoracolumbar osteoporotic vertebral compression fracture(OVCF) by percutaneous vertebroplasty(PVP) approach.Methods A total of 190 patients with thoracolumbar OVCF who received PVP approach treatment in Zhuhai Integrated Traditional Chinese and Western Medicine Hospital from June 2022 to May 2023 were selected and grouped according to envelope method:the control group(n=65),the study group 1(n=41),the study group 2(n=84).The control group received bilateral bone cement injection,the study group 1 received bilateral bone cement injection and bone meal injection,and the study group 2 received bilateral mixed bone cement injection and bone meal injection,and the patients were followed up for 6 months.The oswestry disability index(ODI) score,visual analogue scale(VAS) score before surgery,1 day after surgery,3 months after surgery and 6 months after surgery,Cobb angle and kyphosis angle(KA),anterior vertebral height(ABH),middle vertebral height(MBH) and bone mineral density levels before surgery and at the last follow-up were recorded.Complications during the follow-up period were recorded.Results After 1 day,3 months,and 6 months of surgery,there was statistically significant difference in the ODI scores of the three groups of patients(P<0.05),among them,the ODI scores of the study group 1 and the study group 2 were lower than those of the control group,while the ODI scores of the study group 2 were lower than those of the study group 1,and the differences were statistically significant(P<0.05).There was no statistically significant difference in VAS scores among the three groups at 3 and 6 months after surgery(P>0.05);at 1 day after surgery,there was statistically significant difference in VAS scores of the three groups(P<0.05),the VAS scores of the study group 1 and the study group 2 were lower than those in the control group,while those in the study group 2 were lower than those in the study group 1,the differences were statistically significant(P<0.05).At 1 day,3 months,and 6 months after surgery,there was statistically significant difference in the Cobb angles of the three groups,and the differences were statistically significant(P<0.05),among them,the Cobb angles of the study group 1 and the study group 2 were smaller than those in the control group,while those in the study group 2 were smaller than those in the study group 1,and the differences were statistically significant(P<0.05).At the last follow-up,there were statistically significant differences in KA,ABH,and MBH of the three groups(P<0.05),among them,the KA of the study group 1 and the study group 2 was lower than that in the control group,while ABH and MBH were higher than those in the control group,in addition,the KA of the study group 2 was lower than that of the study group 1,while ABH and MBH were higher than those in study group 1,and the differences were statistically significant(P<0.05).During the follow-up period,the total incidence of complications in the study group 2 was 3.57%,which was lower than that in the control group(12.31%) and the study group 1(24.39%),and the difference was statistically significant(P<0.05).Conclusion In the treatment of thoracolumbar OVCF by the PVP approach,compared with the use of bone cement alone and partial use of bone meal,the combination of bone cement and bone meal regimens resultes in better functional recovery and pain relief,improves vertebral angle and bone mineral density indices,and reduces the risk of postoperative complications and proximal cone fractures.