骨折时间对经皮椎体成形术手术后胸腰椎体内骨水泥弥散的影响

Study on the Effect of Fracture Time on Thoracolumbar Bone Cement Dispersion after Percutaneous Vertebroplasty

目的研究骨折时间对经皮椎体成形术（PVP）手术后胸腰椎体内骨水泥弥散的影响。方法选择2010年1月至2014年12月在北京和平里医院行PVP手术的胸腰椎体压缩性骨折患者134例，根据骨折至手术时间，分为急性组（骨折时间〈3周）44例、亚急性组（骨折时间3～6周）44例、陈旧组（骨折时间〉6周）46例，记录骨水泥注入量；手术后对患者进行CT复查，采用CT影像呈现患者术后椎体内骨水泥弥散情况，观察骨水泥的形状，判断骨水泥在椎体内是偏心分布还是均匀分布；比较患者的骨水泥弥散体积和患者椎体体积；根据CT影像统计患者的骨水泥渗漏情况，记录两组患者术后不良反应发生情况。结果急性组、亚急性组、陈旧组骨水泥注入量、骨水泥弥散特征、骨水泥弥散范围、骨水泥形状等比较差异无统计学意义（P〉0．05）；急性组骨水泥弥散系数、骨水泥弥散体积高于亚急性组和陈旧组[（2．52±0．21）比（2．34±0．37），（2．13±0．20）；（11．4±3．1）mL比（8．5±1．3）mL，（6．6±2．2）mL]，亚急性组骨水泥弥散系数、骨水泥弥散体积高于陈旧组，差异有统计学意义（P〈0．05）；陈旧组不良反应发生率高于亚急性组和急性组[23．91％（11／46）比11．36％（5／44）、4．55％（2／44），P〈0．05]。结论骨水泥的弥散系数随着骨折时间的延长而降低，胸腰椎体压缩性骨折患者尽早手术，以提高骨水泥弥散系数，提高手术治疗效果。

Objective To study the effect of fracture time on thoracolumbar bone cement dispersion after percutaneous vertebroplasty（PVP）. Methods Total of 134 patients with thoracolumbar compression fractures treated with PVP surgery in HepingLi Hospital of Beijing from Jan. 2010 to Dec. 2014 were included, and according to the time interval from fracture to operation, 134 cases were assigned as acute group（ （fracture time 〈 3 weeks）, sub-acute group （fracture time 3-6 weeks）and old group（ fracture time 〉 6 weeks）. Bone cement injection volume was recorded. After operation, the patients were examined with CT to observe the dispersion of bone cement, and the shape of bone cement in the vertebral body to judge if the cement was eccentrically or evenly distributed ; the volume of bone cement and the volume of vertebral body in patients was compared, and the incidence of adverse reactions after operation according to the CT image of the bone cement leakage of the two groups were recorded. Results Bone cement injection volume, bone cement dispersion characteristics, bone cement shape in the acute group, subcute group and old group had no statistically significant difference （ P 〉 0. 05 ） ; the bone cement dispersion coefficient and the diffuse volume of the acute group was higher than the sub-acute group and old group[ （2.52 ±0. 21 ） vs （2. 34 ±0.37）, （2. 13 ±0. 20） ; （ 11.4 ± 3.1 ） mL vs （8.5 ± 1.3 ） mL, （ 6.6 ± 2.2 ） mL ] , bone cement diffusion coefficient and bone cement diffuse volume of the sub-acute group was higher than the old group, the difference was statistically significant （P 〈 0. 05 ） ; the adverse reaction rate of the old group wassignifieantly higher tha the acute group and sub-acute group [ 23.91% （ 11/46 ） vs 11.36% （ 5/44 ）, 4. 55% （ 2/44 ）, P 〈 0. 05 ]. Conclusion Diffusion coefficient of bone cement decreases with the prolonging of the fracture time. Patients with thoracolumbar vertebral compression fracture should receive surgery as soon as possible, to improve the bone cement dispersion coefficient, and the therapeutic effect.