椎体强化在骨质疏松性椎体压缩骨折中的应用

Vertebral augmentation for the treatment of vertebral compression fractures subsequent to osteoporosis

目的分别以聚甲基丙烯酸甲酯骨水泥(PMMA)和碳酸化羟基磷灰石水泥(CHC)作为椎体强化充填材料,采用椎体成形术和后凸成形术治疗骨质疏松性椎体压缩骨折,观察其临床疗效。方法58例骨质疏松性椎体压缩骨折采用以下4种方法治疗:椎体成形术+PMMA(11例13个椎体),椎体成形术+CHC(23例26个椎体),后凸成形术+PMMA(8例8个椎体),后凸成形术+CHC(16例19个椎体)。根据术前和术后侧位X线片计算椎体高度压缩率和恢复率、后凸角度和恢复率,并采用VAS(visualanalogscale)进行术前和术后疼痛评分。结果所有患者均未出现并发症。后凸成形术椎体高度恢复率和后凸角度恢复率优于椎体成形术。椎体增强材料充填剂量各组间无显著性差异。椎体成形术手术时间明显短于后凸成形术。VAS评分术前各组无显著性差异,术后充填PMMA者优于充填CHC者,术后4周二者间无显著性差异。结论椎体强化是一种微创、安全、有效治疗骨质疏松性椎体压缩骨折的方法,应根据患者的具体情况选择治疗方法和椎体充填材料。

Objective To determine the efficacy of vertebroplasty and kyphoplasty with polymethylmethacrylate （PMMA） and carbonated hydroxyapatite cement （CHC） as augmenting biornaterials in the treatment of osteoporosis vertebral compression fractures subsequent to osteoporosis. Methods 58 patients of osteoporosis with vertebral compression fractures were treated with the following methods. vertebroplasty＋PMMA （11 cases, 13 vertebra）, vertebroplasty＋CHC （23 cases, 26 vertebrae）, kyphoplasty＋PMMA （8 cases, 8 vertebrae）, and kyphoplasty＋ CHC （16 cases, 19 vertebrae）. The height loss and kyphotic angle of vertebral compression fractures were respectively measured from preoperative and postoperative lateral X-ray films, and with them the restored height ratio and kyphosis angle ratio were calculated. Both preoperafion and postoperation pain scores were evaluated by Visual Analog Scale （VAS）. Results No complication was found in all the patients. The restored ratio of both vertebra heights and kyphotic angles by kyphoplasty was better than that by vertebroplasty. There was no difference of filling volume in all the groups. The operation time of vertebroplasty was significantly shorter than that of kyphoplasty. There was no difference in preoperative VAS scores. The VAS scores of PMMA groups were better than that of CHC groups, but the difference was not obvious 4 weeks after operation. Conclusion Vertebral augmentation was a minimally invasive, safe and effective method for the treatment of osteoporosis vertebral compression fractures in patients with osteoporosis. The treatment rnodality and filling biomaterials should be selected according to the patients＇ condition.