腰椎经皮椎体后凸成形术后骨水泥分布与椎体再骨折的相关性分析

Analysis of the correlation between bone cement distribution and vertebral refracture after lumbar percutaneous vertebroplasty kyphoplasty

目的研究骨质疏松性椎体骨折患者经皮椎体后凸成形术（PKP）后骨水泥注入位置和剂量对发生椎体再骨折的风险影响。方法选择经PKP术治疗的单椎体骨质疏松性胸腰段椎体压缩骨折患者78例，根据术后骨水泥在椎体中的位置分为侧方组35例和中位组43例。比较手术前后两组VAS、ODI评分、椎体矢状面指数（SI）及Cobb角。并分析骨水泥渗漏情况的发生与骨水泥注入量的关系。结果侧方组、中位组治疗前后VAS、ODI评分、SI及Cobb角组内差异均有统计学意义（均P〈0．05），组间差异均无统计学意义（均P〉0．05）；渗漏组与非渗漏组骨水泥注入量差异具有统计学意义（P〈0．05）。结论PKP治疗骨质疏松性椎体骨折疗效显著，骨水泥的侧分布与椎体向偏侧塌陷无关，骨水泥注入剂量是发生骨水泥渗漏的危险因素，会增加椎体再骨折的风险。

Objective To research the risk of osteoporotic vertebral fractures with PKP after the PMMA injected location and dose of occurrence of vertebral refracture. Methods 78 cases of vertebral osteoporotic thoracolumbar vertebral compression fracture patients with PKP treatmentin were selected. According to position of postoperative PMMA in the vertebral body, they were divided into the side of the group of 35 patients and a median group of 43 patients. Compared two groups of patients before and after surgery, VAS, ODI score, the SI and Cobb angle and analyzed the PMMA leakage occur with the relationship of the amount of bone cement injected. Results There were significant differences in visual analogue pain scale（ .VAS）, Oswestry disability index（ ODI）, sagittal index（SI） and Cobb angle of each group preoperatively versuspostoperatively （ all P 〈 0.05 ）. No statistical difference was noted in the VAS, ODI, SI and Cobb angle between two groups preoperatively versus postoperatively（ all P 〉 0.05 ）. PMMA injection volume between the the leakage group and the non-leakage patients had statistically significant difference （ P 〈 0.05 ）. Conclusion PKP could obtain better clinical therapeutic effect in osteoporotic vertebral fractures treatment. Different PMMA positions had no significant influence on the therapeutic results. PMMA injected dose is a risk factor for bone cement leakage,which will increase the risk of vertebral fractures again.