中粘度与高粘度骨水泥治疗骨质疏松性椎体压缩骨折的疗效对比

Comparison of medium-viscosity cement with high-viscosity cement percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures

目的探讨中粘度与高粘度骨水泥注入在经皮椎体成形术治疗骨质疏松性椎体压缩骨折(OVCF)的临床疗效对比。方法对2012-10-2015-03采用PVP治疗且随访时间≥1年的118例骨质疏松性椎体压缩骨折患者资料进行回顾性分析,按使用骨水泥粘度不同分为2组:中粘度组71例,男21例,女50例,平均年龄为(68.6±8.6)岁,应用中粘度骨水泥进行治疗。高粘度骨水泥组47例,男15例,女32例;平均年龄为(69.1±8.9)岁,应用高粘度骨水泥进行治疗。对两组患者的手术时间、骨水泥注入量、骨水泥渗漏率、骨折椎体高度恢复程度、后凸Cobb角矫正度数、疼痛视觉模拟评分(VAS)及Oswestry功能障碍指数(ODI)进行对比分析。结果高粘度组患者手术时间[(40.6±9.2)min]较中粘度组[(49.2±10.3)min]短,高粘度组患者骨水泥渗漏率[27.7%(13/47)]较中粘度组[36.6%(26/71)]低,差异均有统计学意义(P<0.05)。骨水泥注入量、术后椎体前缘压缩改善程度及后凸Cobb角矫正度数比较,两组差异均无统计学意义(P≥0.05)。两组患者术后VAS、ODI评分均明显低于术前,差异有统计学意义(P<0.05),两组患者术后3个月VAS评分低于术后24 h,术后12个月ODI评分低于术后3个月,比较差异有统计学意义(P<0.05)。两组患者之间术后VAS、ODI评分比较差异无统计学意义(P≥0.05)。结论中粘度与高粘度骨水泥应用于经皮椎体成形术治疗骨质疏松性椎体压缩骨折均能获得满意的临床效果,高粘度骨水泥操作简单,注射易操控,骨水泥渗漏率低,相对中粘度骨水泥手术安全性高,值得临床推广应用。

Objective To compare the clinical efficacy and safety of medium-viscosity cement with high-viscosity cement percutaneous vertebroplasty（PVP） in the treatment of osteoporotic vertebral compression fractures （OVCF）. Methods 118 patients with OVCF who had been treated by PVP in our department from October 2012 to March 2015 were enrolled in this study and they were followed up for at least one year. They were randomly assigned into two groups according to the bone-cements used. In the medium-viscosity cement group, there were 71 patients, including 21 males and 50 females with a mean age of （68.6±8.6） years. In the high-viscosity cement group, there were 47 patients, including 15 males and 32 females with a mean age of （69.1 ± 8.9） years. These two groups were compared in terms of operation time,bone cement volume injected, cement leakage, vertebral height restoration, kyphosis correction,Visual Analog Seale（VAS） and Oswestry Disability Index（ODI）. Results The high-viscosity cement group incurred significantly shorter operation time （40.6 ±9.2） min and significantly less cement leakage rate（27.7%） than the medium-viscosity cement group [（49.2 ± 10.3） rain and 36.6%, P〈0.05]. There were no significant differences between these 2 groups in bone cement volume injected, anterior vertebral height restoration or kyphosis correction （P≥0.05）. The VAS, OD1 scores at postoperation were significantly lower than preoperation in both two groups （P〈0.05）. The VAS score at 3 months postoperation was significantly lower than 24 h （P〈0.05）, the ODI score at 12 months postoperation was significantly lower than 3 months（P〈0.05）, but there were no significant difterenees between two groups （P≥0.05）. Conclusion Both medium-viscosity cement and high-viscosity cement PVP can obtain satisfactory analgesia for the treatment of OVCF. But high-viscosity cement PVP might have advantages of simple operation, easy handling of injection, low bone cement leakage rate, more surgical safety performance in the clinical application and the actual situation of operation the operator reasonable choice, and is worthy of elinieal application.