骨水泥温度梯度灌注技术在经皮椎体后凸成形术中的应用

Temperature gradient cement injection technique in percutaneous vertebroplasty for osteoporotic vertebral compression fractures

目的：通过与传统的骨水泥单次灌注技术进行比较,评估骨水泥温度梯度灌注技术在经皮椎体后凸成形术（PKP）治疗骨质疏松性椎体骨折（OVCF）中的临床疗效。方法：收集我院2006年1月~2010年1月共234例行PKP的OVCF患者,根据骨水泥灌注方法的不同分为温度梯度灌注组（采用缓慢、低压、间隔1~2min将骨水泥分次灌注入椎体内）和传统灌注组（采用传统的骨水泥调制好一次性灌注的方法）。温度梯度灌注组：129例患者,160个手术椎体;传统灌注组：105例患者,128个手术椎体。比较术后1周内及末次随访时两组的VAS评分、ODI、伤椎椎体后凸角、伤椎前缘相对高度及骨水泥渗漏率。结果：温度梯度灌注组术后随访25.3±12.2个月;传统灌注组术后随访24.7±11.5个月,两组间差异无显著性（P〉0.05）。温度梯度灌注组：术前VAS评分、ODI、伤椎的椎体后凸角及前缘相对高度分别为7.19±0.94、71.55±7.83、16.66°±8.40°和（62.50±24.64）%;术后为2.18±0.62、28.86±4.71、11.72°±7.81°和（84.50±14.92）%;末次随访时为2.1±1.9、28.79±6.25、11.87°±8.34°和（85.49±12.67）%。传统灌注组：术前VAS评分、ODI、伤椎的椎体后凸角和前缘相对高度分别为7.20±1.07、70.49±9.28、16.97°±9.48°和（61.91±24.84）%;术后为2.25±0.64、28.55±4.46、11.90°±7.42°和（85.09±10.71）%;末次随访时为2.3±2.5、28.51±6.55、11.92°±9.03°和（85.10±14.61）%。两组患者VAS评分、ODI、伤椎的前缘相对高度和椎体后凸角手术后与手术前比较均有统计学差异（P〈0.05）;末次随访时与术后比较无统计学差异（P〉0.05）;两组之间比较术前、术后及末次随访时的上述指标均无统计学差异（P〉0.05）。传统灌注组有9例患者发生骨水泥渗漏,渗漏率8.60%;温度梯度灌注组有3例患者发生骨水泥渗漏,渗漏率2.3%,显著低于传统灌注组的骨水泥渗漏率（P〈0.05）。结论：骨水泥温度梯度灌注技术可以获得满意的影像学及临床效果,并且可以显著降低骨水泥渗漏的发生率。

Objectives： To explore the clinical efficacy and complications of temperature gradient cement in-jection technique in percutaneous vertebroplasty（PKP） for osteoporotic vertebral fractures（OVCF）, by comparing with traditional single time cement injection technique. Methods： A total of 234 patients with OVCF from January 2010 to January 2006 were reviewed. The patients were divided into temperature gradient cement in-jection group（slow, low pressure, staged cement injection with 1-2 min intervals） and the traditional cement injection group（one time cement injection）. Temperature gradient cement injection group included 129 patients with 160 vertebral fractures. Traditional injection group included 105 patients with 128 vertebral fractures.Outcomes were evaluated pre- and postoperatively by using visual analogue score（VAS）, Oswestry dability in-dex（ODI）, the local kyphosis angle, the anterior relative vertebral height ratio and the occurrence of cement leakage. Results： The average follow-up was 25.3 ±12.2 months in temperature gradient cement injection group, 24.7±11.5 months in the traditional cement injection group, and there was no significant difference between two groups（P0.05）. The temperature gradient cement injection group： VAS score, ODI, local vertebral kyphosis angle and the relative anterior vertebral height ratio was 7.19 ±0.94, 71.55 ±7.83, 16.66° ±8.40°,（62.50±24.64）% respectively before surgery, 2.18±0.62, 28.86±4.71, 11.72°±7.81°,（84.50±14.92）% respectively after surgery, and 2.1±1.9, 28.79±6.25, 11.87°±8.34°,（85.49±12.67）% respectively at the final follow-up. The traditional injection group： VAS score, ODI, local vertebral kyphosis angle and anterior relative height ratio was 7.20±1.07, 70.49±9.28, 16.97°±9.48°,（61.91±24.84）% respectively before surgery, 2.25±0.64, 28.55±4.46,11.90° ±7.42°,（85.09 ±10.71）% respectively after surgery, and 2.3 ±2.5, 28.51 ±6.55, 11.92° ±9.03°,（85.10 ±14.61）% respectively at the final follow-up. The VAS score, ODI, local vertebral kyphosis angle and the relative anterior vertebral height ratio were significantly improved after operation in both groups（P〉0.05）. There was no significant difference of the outcomes between postoperation and final follow-up（P〉0.05）. There was no significant difference between two groups preoperatively, postoperatively and at the final follow-up（P〉0.05）.Cement leakage occured in only 3 patients（2.3%） in temperature gradient cement injection group, which was significantly less than traditional cement injection group（8 patients, 8.6%）（P〈0.05）. Conclusions： Satisfactory imaging and clinical results can be obtained by the method of temperature gradient cement injection technique. Also, it can reduce the incidence of bone cement leakage.