骨水泥在椎体骨折线内弥散状况对PVP疗效影响的研究

The study of dispersion of bone cement on the effect of PVP on the vertebral fractures

目的研究在经皮椎体成形术（PVP）中骨水泥在椎体骨折线内弥散情况对疗效的影响。方法选自2009年5月-2013年6月因椎体压缩性骨折而在我院行PVP手术的106例患者进行回顾性分析。将患者分成两组,A组74例：骨水泥在骨折线内充分弥散,B组32例：骨折线内骨水泥弥散不佳。记录手术前以及手术后4d以及末次随访时的功能障碍指数（ODI）疼痛视觉模拟评分（VAS）、局部后凸Cobb角,将末次随访与术后4d局部Cobb角之差定义为后凸纠正缺失量。结果两组患者术后4d及末次随访时的ODI、VAS评分较术前明显改善（P〈0.05）,术后4d时的ODI、VAS评分术前值的改善A组明显优于B组（P〈0.05）。末次随访时两组患者ODI、VAS评分差异无统计学意义（P〉0.05）。两组患者术后4d局部Cobb角均较术前明显改善（P〈0.05）,A组术后4d时Cobb角与末次随访相比差异无统计学意义（P〉0.05）,B组术后4d时Cobb角与末次随访相比显著增大（P〈0.05）。结论 PVP手术可改善椎体压缩性骨折患者功能障碍,疼痛程度,且骨折线内骨水泥弥散不佳会影响近期疗效,并可能导致PVP术后后凸性畸形。

Objective To investigate the effect of bone cement dispersion in vertebral fracture line on clinical efficiency of PVP. Methods 106 patients with PVP surgery in our hospital were selected to analyzed from May 2009 to June 2013.The patients were divided into two groups.A group of 74 people：bone cement in the fracture line was full dispersion.B group of 32 people：bone cement in the fracture line was poor dispersion.Oswestry disability index（ODI）,pain visual analogue scale（VAS）,Locally convex Cobb angle were recorded before,4 days after surgery and at the last time of follow-up.The difference of Locally convex Cobb angle between 4 days after surgery and the last time of follow-up was defined as the loss of the posterior convex correction. Results The ODI and VAS scores in 4 days after surgery and at the last time of follow-up were significantly improved compared with preoperative（P 〈0.05）;the preoperative values of ODI and VAS scores in group A were significantly better than group B（P 〈0.05）.ODI and VAS scores of two groups at last follow had no significantly difference（P 〉0.05）.Four days after surgery,Locally convex Cobb angle of two groups were significant improvement compared with preoperative（P 〈0.05）.Locally convex Cobb angle of A group was no significant difference between 4 days after surgery and last follow-up（P 〉0.05）while that was significant increased in B group（P 〈0.05）. Conclusion PVP surgery can improve the functional disability and pain of vertebral compression fractures, and the poor bone cement dispersion in the fracture lines can affect the shortterm effects,and may result in the post PVP operation.