高黏度骨水泥与传统骨水泥治疗骨质疏松性椎体压缩性骨折的疗效比较

Comparison of high viscosity bone cement and traditional bone cement for osteoporotic vertebral compression fractures

目的比较高黏度骨水泥与传统聚甲基丙烯酸甲酯（PMMA）骨水泥治疗骨质疏松性椎体压缩性骨折的疗效,探讨高黏度骨水泥在临床应用中的优势。方法选择2009年7月~2013年7月治疗并获得随访160例骨质疏松性椎体压缩性骨折患者,其中男性64例,女性96例;年龄61~88岁,平均年龄69.1岁。分高黏度骨水泥组[91例（112个椎体）]和传统骨水泥组[69例（86个椎体）]。高黏度骨水泥组,采用以色列Disc-O-Tech公司Confidence骨水泥,施行经皮椎体成形术（PVP）;传统骨水泥组,采用PMMA骨水泥,施行PVP。术后对比两组患者视觉疼痛模拟评分（VAS）、责任椎Cobb角的恢复情况及术后骨水泥渗漏情况,并随访观察。结果高黏度骨水泥组与传统骨水泥组VAS评分（1.5±0.8vs1.4±0.9）比较差异无统计学意义（P〉0.05）;高黏度骨水泥组Cobb角恢复优于传统骨水泥组（13.6°±3.1°vs 19.8°±3.0°）,差异有统计学意义（P〈0.05）;高黏度骨水泥组渗漏率远低于传统骨水泥组（19.6%vs 41.9%）,差异有统计学意义（P〈0.05）。所有患者术后获得3~48个月（平均16个月）随访,其中3例出现神经根症状,所有患者未出现感染、肺栓塞等并发症。结论高黏度骨水泥与传统PMMA骨水泥相比,在纠正椎体Cobb角及降低骨水泥渗漏发生率方面效果更佳,明显提高了PVP的安全性及有效性。

Objective To compare the curative efficacy of high viscosity bone cement with traditional polymethylmethacrylate（PMMA） bone cement in the treatment of osteoporotic vertebral compression fractures, and explore the advantages of high viscosity bone cement in clinic. Methods A total of 160 cases of osteoporotic vertebral compression fractures from July 2009 to July 2013were enrolled, which included 64 males and 96 females, aged 61- 88 years old with mean age of 69.1. They were divided into high viscosity bone cement group[n = 91, 112 vertebras performed percutaneous vertebroplasty（PVP） with confidence bone cement] and traditional bone cement[n = 69, 86 vertebras, performed PVP with traditional bone cement]. The visual analogue scale（VAS） scores,recovery of Cobb angle and cement leakage rate at postoperative were compared and followed-up. Results The VAS scores were no statistically significant difference between high viscosity bone cement group and traditional bone cement group（1.5 ± 0.8 vs 1.4 ± 0.9,P ＆gt; 0.05）; The recovery of Cobb angle in high viscosity bone cement was superior to that in the traditional bone cement group（13.6°±3.1° vs 19.8° ± 3.0°）, the difference was statistically significant（P ＆lt; 0.05）; The leakage rate in high viscosity bone cement was much lower than that in the traditional bone cement group（19.6 % vs 41.9 %）, the difference was statistically significant（P ＆lt; 0.05）. All the patients were obtained follow-up of 16 months（3- 48 months）. The radicular symptoms were observed in 3 patients, and no infection and pulmonary embolism occurred in all patients. Conclusion It is demonstrated that compared with traditional PMMA bone cement, high viscosity bone cement makes significant improvement in correction of Cobb angle and the reduction of cement leakage. It is increased the efficacy and safety of PVP obviously.