聚甲基丙烯酸甲酯骨水泥椎体成形修复老年复发性骨质疏松椎体骨折:1年功能随访报告

Percutaneous vertebroplasty with polymethylmethacrylate bone cement for treating elderly recurrent osteoporotic vertebral compression fractures: a report of 1-year functional follow-up

背景:如何针对65岁以上老年人复发性骨质疏松椎体骨折进行有效治疗,成为临床治疗的重点和关注点。目的:评价采用聚甲基丙烯酸甲酯骨水泥椎体成形修复老年复发性骨质疏松椎体骨折的临床疗效。方法:选择24例老年复发性骨质疏松椎体骨折患者,按照患者自愿原则分别进行聚甲基丙烯酸甲酯骨水泥椎体成形治疗(微创组)和保守治疗(保守组),每组12例。对比治疗前后的腰背部目测类比评分、Oswesty功能障碍指数、伤椎前后缘高度比、脊柱后凸Cobb角及不良反应。结果与结论:两组均完成12个月随访,微创组1例治疗时发生骨水泥渗漏,保守组1例治疗后1个月发生下肢深静脉血栓;微创组治疗后3 d、1个月、3个月、6个月、12个月的目测类比评分、Oswesty功能障碍指数、脊柱后凸Cobb角均低于保守组(P<0.05),治疗后3 d、1个月、3个月、6个月、12个月的伤椎前后缘高度比均高于保守组(P<0.05)。结果表明采用聚甲基丙烯酸甲酯骨水泥灌注修复老年复发性骨质疏松椎体骨折,近期可有效缓解疼痛,远期恢复了椎体高度和脊柱生理曲度,患者生活质量得到显著改善。

BACKGROUND： How to effectively treat recurrent osteoporotic vertebral compression fractures in the elderly over 65 years has become an issue of attention in the clinic. OBJECTIVE： To evaluate the clinical efficacy of percutaneous vertebroplasty with polymethylmethacrylate bone cement for treating elderly recurrent osteoporotic vertebral compression fractures. METHODS： Twenty-four patients with elderly osteoporotic vertebral compression fractures were divided into polymethylmethacrylate bone cement group（minimally invasive group） and conservative treatment group on a voluntary basis（n=12 per group）. Visual analog scale score for low back pain, Oswesty dysfunction index, ratio of the anterior/posterior margin height of the injured vertebra, Cobb angle and adverse reactions were compared between the two groups before and after treatment. RESULTS AND CONCLUSION： The 12-month follow-up was completed in all the patients. There was one case of bone cement breakage during treatment in the minimally invasive group and one case of lower limb deep venous thrombosis in the conservative treatment group at 1 month after treatment. Compared with the conservative treatment group, the visual analog scale score, Oswesty dysfunction index, and Cobb angle were significantly lower, but the ratio of the anterior/posterior margin height of the injured vertebra was significantly higher in the minimally invasive group at 3 days, 1, 3, 6 and 12 months after treatment（P〈0.05）. These findings indicate that percutaneous vertebroplasty with polymethylmethacrylate bone cement for elderly recurrent osteoporotic vertebral fractures can strive for short-term pain relief and long-term recovery of the vertebral height and spinal Cobb angle, thereby significantly improving patient＇s quality of life.