椎体成形术中骨水泥弥散分布等级的量效关系

Dose-effect relationship of bone cement dispersed level in vertebroplasty

目的提出椎体成形术骨水泥弥散等级分级理论,对不同等级下的止痛效果、腰椎功能进行评价。方法收集椎体成形术患者57例,根据正侧位X线片简便判断出骨水泥分布等级并进行分组,对术前、术后1周、术后3个月各组间止痛效果、腰椎功能障碍指数进行比较。结果 57例获得平均7个月的随访。57例中14例出现椎体周围骨水泥外渗的情况,未出现神经症状或原有症状加重,每个椎体内注入骨水泥量1.5-5.0（2.6±1.1）ml,57例根据骨水泥弥散等级分为3组,VAS、ODI评分各组内术后与术前比较差异有统计学意义（P〈0.001）;术后1周、3个月的组间VAS评分差异无统计学意义（P〉0.05）,但在术后1周1级组与3级组ODI评分差异有统计学意义（P〈0.05）;而3个月后各组间ODI评分差异无统计学意义（P〉0.05）。结论经皮椎体成形术（PVP）各级骨水泥弥散等级均可有效缓解椎体压缩骨折引起的疼痛,疼痛缓解程度与骨水泥弥散程度不成比例关系;但在椎体成形术后早期骨水泥弥散等级对脊柱功能障碍指数影响存在统计学意义,认为该分级方法对PVP术后早期脊柱功能评价存在临床指导意义。

Objective To propose a vertebroplasty surgery bone cement dispersion level hierarchical theory, and evaluate the analgesic effect of different levels, lumbar function. Methods Fifty seven vertebroplasty cases were included. According to the lateral X-rays, bone cement distribution level was determined and divided into groups. The analgesic effect, the lumbar dysfunction index were compared and evaluated among the groups, before operation and 1 week and 3 months after operation.Results Fifty seven patients underwent vertebroplasty successfully with an average of 7 months follow-up. Bone cement extravasation around vertebrae occurred in 14 cases, no neurological symptoms or aggravated existing symptoms occurred. The amount of bone cement injected was 1.5-5.0 ml, average（2.6 ±1.1）ml each vertebra. According to bone cement dispersion level, 57 patients were divided into three groups. There were significant differences in VAS, ODI scores before operation and after operation within each group（P 〈0.001）; One week, three months after operation, the VAS scores were not statistically different（P 〉0.05）, but in one week after operation, ODI score of level one group with level three group was statistically significantly different（P 〈0.05）. Three months after operation, the ODI score was not significantly differentamong groups（ P 〉0.05）. Conclusion The percutaneous vertebroplasty at all levels bone cement dispersion level can effectively alleviate the pain caused by vertebral compression fractures. The degree of pain relief is not related with the level of bone cement dispersion proportionately. But there is significant influence of early bone cement dispersion level on spinal dysfunction index after vertebroplasty. Our vertebroplasty surgery bone cement dispersion level hierarchical theory can serve as a clinical guide for evaluation of the early spinal function after PVP.