经皮椎体成形高黏度骨水泥注入修复老年椎体压缩骨折:椎体高度恢复评价

Percutaneous vertebroplasty with high-viscosity bone cement injection for repair of osteoporotic vertebral compression fractures in the elderly: evaluation of vertebral height recovery

背景:在应用高黏度骨水泥以及椎体成形修复骨质疏松性椎体压缩骨折的过程中,骨水泥的推注量-压缩椎体高度的恢复-临床疗效"之间是否存在必然联系以及内在的规律,目前缺乏此方面的循证医学证据,且存在一定争议。目的:观察经皮椎体成形高黏度骨水泥注入修复老年骨质疏松椎体压缩性骨折的椎体高度恢复情况。方法:选取2011年1月至2012年12月新疆维吾尔自治区中医医院脊柱外科收治的骨质疏松压缩性骨折老年患者110例,共139椎,均由同一组外科医生采用经皮椎体成形治疗,在骨水泥拉丝期时在"G"形臂监视下将高黏度骨水泥注入骨折椎体内。治疗后随访12个月,以目测类比评分、Barthel指数、椎体高度恢复为观察评价指标。结果与结论:110例患者共139椎,修复过程顺利,单个椎体骨水泥平均注入量为3-6 mL,平均3.5 mL。患者的目测类比评分由治疗前平均7.9分降到了治疗后12个月的平均1.8分;Barthel指数治疗前平均为40.25,治疗后12个月时为82.21,治疗后与治疗前比较目测类比评分和Barthel指数均有明显改善(P<0.05)。治疗后139个椎体前、中部的高度增加到了原椎体高度的(81.25±9.26)%和(78.22±10.65)%,治疗后24 h、3个月、12个月与治疗前相比椎体前部、中部高度均有显著恢复(P<0.05)。治疗后通过随访观察发现,发生高黏度骨水泥渗漏的椎体有5个,以上患者未出现临床症状,未发生神经损伤或肺栓塞等严重并发症。提示经皮椎体成形高黏度骨水泥注入修复骨质疏松性椎体压缩性骨折的过程中,不仅可以有效缓解患者疼痛,在不同程度上恢复压缩椎体的高度,而且并发症发生率低,患者恢复时间短。

BACKGROUND： Whether there is a necessary connection or internal patterns between the amount of bone cement-recovery of vertebral height-clinical efficacy has no evidence-based medicine findings in the treatment of osteoporotic vertebral compression fractures using percutaneous vertebroplasty with high-viscosity bone cement injection. OBJECTIVE： To observe the change of vertebral height in the elderly with osteoporotic vertebral compression fractures after percutaneous vertebroplasty with high-viscosity bone cement injection.METHODS： A total of 110 elderly patients with osteoporotic vertebral compression fractures（139 vertebrae） were admitted at the Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region from January 2011 to December 2012. All the patients received percutaneous vertebroplasty by the same group of surgeons. Bone cement at drawing stage was injected into the fractured vertebra. During the 12-month follow-up, visual analogue scale, Barthel index and vertebral height restoration were observed as evaluation indexes. RESULTS AND CONCLUSION： The surgical treatment was done successfully in the 110 patients（139 vertebrae）. The amount of bone cement per vertebra was 3-6 m L, with a mean of 3.5 m L. At 12 months after surgery, the visual analog scale scores were decreased from 7.9 to 1.8, Barthel index was increased from 40.25 to 82.21, both of which were improved significantly（P〈0.05）. After surgery, the vertebral heights at the anterior and middle parts were increased by（81.25±9.26）% and（78.22±10.65）%, respectively, and there was significant differences before ant at 24 hours, 3 months and 12 months after surgery（P〈0.05）. During the follow-up, there were five vertebrae with bone cement leakage, but no clinical symptoms occurred, and no nerve injury or pulmonary embolism happened. These findings indicate that percutaneous vertebroplasty with high-viscosity bone cement injection can effectively relieve pain, restore the vertebral height, reduce the incidence of complications and shorten the recovery time in patients with osteoporotic vertebral compression fractures.