骨水泥的分布与剂量对椎体成形术疗效影响的研究

Influence of distribution and volume of bone cement on outcome of percutaneous vertebroplasty

目的在使用经皮椎体成形术（PVP）治疗脊柱胸腰段（T11-L2）骨质疏松性椎体压缩骨折（OVCFs）中,探讨骨水泥的分布和剂量对患者术后止痛效果的影响。方法选取自2010-01—2012-12行PVP手术的673例,用VAS评分对患者在术前、离院时、术后3个月和术后1年进行随访,按照最终的VAS评分结果,将患者分为A组（0-3分）和B组（〉4分）,比较2组间骨水泥分布情况和注射剂量。结果 673例中622例均获得1年的随访,VAS评分在术前、离院时、术后3个月和术后1年分别为（9.2±0.06）分、（1.4±0.03）分、（1.7±0.04）分和（1.8±0.08）分。其中A组521例,骨水泥注射剂量为3.2-8.0（5.1±0.05）ml;B组101例,骨水泥为3.0-6.5（4.7±0.06）ml,差异无统计学意义（t=0.80,P=0.34）。术后影像学发现骨水泥在A组中的分布比B组在椎体的前柱左右更对称,并且在上下终板间的椎体前缘有连续的骨水泥填充。结论PVP是治疗老年OVCFs的一种简单快速、疗效确实的手术方法;达到骨水泥满意的分布状态是提高手术疗效的关键,而与具体的用量无关。

Objective To evaluate the influence of the distribution and volume of bone cement on the pain relieving among the patients, who underwent the PVP due to the painful osteoporotic vertebral compression fractures（OVCFs） at the thoracolumbar segment（T11-L2）. Methods From Jan. 2010, to Dec. 2012, 673 patients who underwent the PVP operation were selected. The patients＇ outcome was scaled respectively using the VAS at before operation, discharge, according to the VAS resulton the final follow-up, as group A（0-3 scale） and group B（〉4 scale）. The distribution and volume of bone cement were compared between the two groups. Results There＇re 622 of 673 patients who underwent the PVP were followed up for one year. The average VAS scale before operation, discharge, the 3rd and 12 th months postoperatively was（9.2 ±0.06）,（1.4±0.03）,（1.7±0.04） and（1.8±0.08）, respectively. Group A included 521 patients, the mean cement volume was（5.2 ±0.05）ml（3.2-8.0ml）;Group B was composed of 101 patients, the average volume was（4.7 ±0.06）ml（3.0-6.5 ml）, the difference was not statistically significant（t =0.80, P =0.34）. From the radiography in both groups, the cement in group A not only filled the anterior edge of the fractured vertebral body entirely, but also showed more bilateral symmetry in the anterior column than group B. Conclusion PVP is an easy, quick and effective treatment for the senile OVCFs patients. Achieving the satisfactory cement distribution in the anterior column is the key to wonderful result, which has nothing to do with the volume.