不同时相骨水泥对骨质疏松性椎体压缩性骨折患者的影响

Effect of bone cement on patients with osteoporotic vertebral compression fracture

目的比较推注拉丝期和湿沙期聚甲基丙烯酸甲酯(polymethyl methacrylate,PMMA)骨水泥对骨质疏松性椎体压缩性骨折患者手术治疗效果的影响。方法将郑州大学附属郑州中心医院2019年1月—2020年4月期间收治的骨质疏松性椎体压缩性骨折患者74例作为研究对象。采用随机数字表法将患者随机分为观察组(湿沙期推注骨水泥,n=38例)和对照组(拉丝期推注骨水泥,n=36例),所有患者均完成12个月的随访,比较两组患者Oswestry功能障碍指数问卷表(ODI)评分、评分和疼痛视觉模拟评分(VAS评分)、手术相关指标、邻近椎体骨折,责任椎再骨折,骨水泥渗漏发生率。结果观察组椎体恢复高度、骨水泥注入量分别为(5.36±0.67)mm和(4.23±0.62)mL,均高于对照组的(4.14±0.83)mm和(3.97±0.78)mL(t=6.317、6.028,P均<0.05)。术前两组ODI评分和VAS评分比较差异均无统计学意义(P均>0.05),术后各个时间点两组患者ODI评分和VAS评分均得到明显改善(对照组F=362.17、432.17,观察组F=569.83、456.67,P均<0.05),术后即刻、术后2d、术后3个月两组患者ODI评分和VAS评分比较差异均有统计学意义(ODI评分比较t=6.528、6.317、6.569,VAS评分t=6.563、6.237、5.892,P均>0.05)。对照组随访期间邻近椎体骨折,责任椎再骨折发生率分别为13.89%,11.11%,均明显高于观察组的5.26%,5.26%,两组比较差异均有统计学意义(χ;=8.127、7.358,P均<0.05)。结论骨质疏松椎体压缩性骨折采用经皮椎体后凸成形术治疗时推注湿沙期骨骨水泥效果更好,可进一步提高患者疗效,使疼痛和关节功能等缓解更快更好,并发症发生率也更低。

Objective To compare the effect of PMMA bone cement in wire drawing stage and wet sand stage on the surgical treatment of osteoporotic vertebral compression fractures.Methods Totally 74 patients with osteoporotic vertebral compression fractures in our hospital from January 2019 to April 2020 were selected as the research objects.The patients were randomly divided into the observation group(38 cases in wet sand period)and the control group(36 cases in wire drawing period).All patients were followed up for 12 months.The ODI score,VAS score,operation related indexes,adjacent vertebral fracture,refracture of responsible vertebral body and the incidence of bone cement leakage were compared between the two groups.Results The vertebral body recovery height and bone cement injection volume of the observation group were(5.36±0.67)mm and(4.23±0.62)mL,which were higher than(4.14±0.83)mm and(3.97±0.78)mL(t=6.317,6.028,all P<0.05).There was no significant difference in ODI score and VAS score between the two groups before operation(all P>0.05).The ODI score and VAS score of the two groups were significantly improved at each time point after operation(F=362.17,432.17 in the control group,F=569.83,456.67 in the observation group,all P<0.05),There were significant differences in ODI score and VAS score between the two groups 3 months after operation(ODI score t=6.528,6.317,6.569,VAS score t=6.563,6.237,5.892,all P>0.05).During the follow-up period,the incidence of adjacent vertebral fracture and responsible vertebral refracture in the control group were 13.89%and 11.11%respectively,which were significantly higher than 5.26%and 5.26%in the observation group,and the differences between the two groups were statistically significant(χ;=8.127,7.358,all P<0.05).Conclusion When Percutaneous kyphoplasty is used to treat osteoporotic vertebral compression fractures,the effect of injecting bone cement in wet sand stage is better,which can further improve the curative effect of patients,relieve pain and joint function faster and better,and reduce the incidence of complications.