Confidence高黏度骨水泥椎体成形系统结合体位复位治疗急性重度骨质疏松性椎体压缩骨折

Confidence HIGH VISCOSITY BONE CEMENT SYSTEM AND POSTURAL REDUCTION IN TREATING ACUTE SEVERE OSTEOPOROTIC VERTEBRAL COMPRESSION FRACTURES

目的探讨应用Confi dence高黏度骨水泥椎体成形系统结合体位复位治疗急性重度骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)的临床效果。方法回顾分析2004年6月-2009年6月采用Confi dence高黏度骨水泥及其椎体成形系统结合体位复位治疗34例急性重度OVCF患者的临床资料。男14例,女20例;年龄62～88岁,平均72.6岁。均为单椎体骨折。损伤节段:T11 4例,T12 10例,L1 15例,L2 4例,L3 1例。骨密度测定T值均≤—2.5,提示骨质疏松。伤后至入院时间2～72 h。术前先对压缩椎体行腰椎过伸位复位7～14 d,术中采用单侧穿刺,经椎弓根入路,每个椎体注射骨水泥2～6 mL,平均3.2 mL。结果术中3例(8.8%)椎体出现不同程度骨水泥渗漏,其中2例椎体渗漏至椎间隙,1例椎体渗漏至椎旁软组织;均无临床症状,未行处理。患者均无肺栓塞、感染和神经损伤等并发症发生。34例均获随访,随访时间12～38个月,平均18.5个月。术后31例术前疼痛症状完全缓解,3例部分缓解;未见伤椎再骨折、骨与骨水泥界面松动及相邻椎体骨折发生。术后3 d及末次随访时伤椎前中柱椎体高度、后凸Cobb角及疼痛视觉模拟评分(VAS)均较术前显著改善(P<0.05),术后3 d与末次随访时比较差异无统计学意义(P>0.05)。结论 Confi dence高黏度骨水泥椎体成形系统具有瞬间高黏度、可注射时间长、定向可控注射等优点,降低了骨水泥渗漏风险,术前结合体位复位治疗急性重度OVCF疗效较好。

Objective To evaluate the effectiveness of Confidence high viscosity bone cement system and postural reduction in treating acute severe osteoporotic vertebral compression fracture （OVCF）. Methods Between June 2004 and June 2009, 34 patients with acute severe OVCF were treated with Confidence high viscosity bone cement system and postural reduction. There were 14 males and 20 females with an average age of 72.6 years （range, 62-88 years）. All patients had single thoracolumbar fracture, including 4 cases of T11, 10 of T12, 15 of L1, 4 of L2, and 1 of L3. The bone density measurement showed that T value was less than —2.5. The time from injury to admission was 2-72 hours. All cases were treated with postural reduction preoperatively. The time of reduction in over-extending position was 7-14 days. All patients were injected unilaterally. The injected volume of high viscosity bone cement was 2-6 mL （mean, 3.2 mL）. Results Cement leakage was found in 3 cases （8.8%） during operation, including leakage into intervertebral space in 2 cases and into adjacent paravertebral soft tissue in 1 case. No cl inical symptom was observed and no treatment was pearformed. No pulmonary embolism, infection, nerve injury, or other complications occurred in all patients. All patients were followed up 12-38 months （mean, 18.5 months）. Postoperatively, complete pain rel ief was achieved in 31 cases and partial pain refief in 3 cases; no re-fracture or loosening at the interface occurred. At 3 days after operation and last follow-up, the anterior and middle vertebral column height, Cobb angle, and visual analogue scale （VAS） score were improved significantly when compared with those before operation （P 〈 0.05）;and there was no significant difference between 3 days and last follow-up （P 〉 0.05）. Conclusion Confidence high viscosity bone cement system and postural reduction can be employed safely in treating acute severe OVCF, which has many merits of high viscosity, long time for injection, and easy-to-control directionally.