骨水泥注射量与经皮椎体后凸成形术后疗效的临床随机对照研究

Effect of bone cement injection volume on therapeutic results in percutaneous kyphoplasty

目的 探讨经皮椎体后凸成形术在治疗骨质疏松性椎体压缩骨折中2种不同骨水泥注射量与疗效的关系。方法选择自2011-10—2013-10诊治的并筛选合格、符合入选条件的60例骨质疏松性椎体压缩骨折,按照1∶1的比例随机分配到A组和B组。A组：骨水泥用量按照CT测定骨折椎上下椎体体积平均值的15%注入。B组：骨水泥用量按照常规用量即腰椎骨水泥注入量为6 ml;胸椎骨水泥注入量为4 ml。结果 所有患者获随访6~30（9.9±1.2）个月。2组术后1周及6个月时VAS评分、椎体后凸Cobb角及椎体高度恢复率较术前均改善,差异有统计学意义（P〈0.05）,2组间比较差异无统计学意义（P〉0.05）。B组11例治疗椎体发生骨水泥渗漏,A组3例治疗椎体发生骨水泥渗漏,2组骨水泥渗漏率比较差异有统计学意义（P〈0.05）。B组1例发生神经损伤,2例末次随访时发生邻近椎体骨折;A组无一例发生神经损伤,1例末次随访时发生邻近椎体骨折,2组均无肺栓塞发生,2组上述参数比较差异无统计学意义（P〉0.05）。结论 按照骨折椎体体积的15%注射骨水泥治疗骨质疏松性椎体骨折,并发症少、近中期临床疗效满意,值得临床推广应用。

Objective To investigate the relationship between two different bone cement injection volume and its effect in treatment of osteoporotic vertebral compression with percutaneous kyphoplasty. Methods Sixty patients were selected in our hospital between October 2011 to October 2013 were collected eligible, and assigned to group A and group B in accordance with the proportion of 1：1. Group A, the bone cement volume was 15% of the average volume of the upper and lower vertebrae of the fractured vertebra calculated by CT scan. Group B, the bone cement vdume was 6 ml for lumbar vertebra; 4 all for thoracic vertebra. Results All patients were followed up for 6-30 months, mean （9.9±1.2） months. The VAS score, vertebral Cobb angle, vertebral height restoration of two groups of patients were improved 1 week and 6 months after operation（P 〈0.05）, there was no significant difference between the two groups （P 〉0.05）. Eleven patients had bone cement leakage in group B, 3 cases in group A, with significantly difference （P 〈0.05）. In group B, nerve injury occurred in 1 patient, adjacent vertebral fracture occurred in 2 cases at the last follow-up; in group A, nerve injury occurred in no case, adjacent vertebral fracture occurred in 1 case at last follow-up. No pulmonary embolism occurred in two groups, no significant difference was found between the two groups in the above parameters （P 〉0.05）. Conclusion The injection volume of the cement is 15% of the vertebral volume for treatment of osteoporotic vertebral fracture volume fracture, with less complications, short-term and medium-term satisfactory clinical efficacy. It is worthy of clinical application.