应用不同黏度骨水泥行椎体成形治疗骨质疏松性椎体压缩性骨折

Comparison of high-viscosity cement and low-viscosity cement in vertebroplasty for osteoporotic vertebral compression fractures

背景：在经皮椎体成形治疗骨质疏松椎体压缩性骨折时，较高的骨水泥渗漏率限制了其应用，如何避免或减少骨水泥渗漏成为目前本领域研究热点。目的：比较应用高黏度及低黏度骨水泥行椎体成形治疗骨质疏松椎体压缩性骨折的安全性及有效性。方法：纳入骨质疏松椎体压缩性骨折行椎体成形患者92例，107个椎体。根据应用骨水泥不同分为高黏度组（48例，56个椎体）和低黏度组（44例，51个椎体）。高黏度组采用PALACOS R＋G高黏度骨水泥进行治疗，低黏度组采用OSTEOPA V低黏度骨水泥进行治疗。结果与结论：①两组患者治疗后3d目测类比评分及Oswestry功能障碍指数评分：均较治疗前明显改善，但是2组差异无显著性意义；②骨水泥渗漏的总发生率及椎间盘渗漏率：高黏度组比低黏度组显著降低，但2组椎体周围、沿血管、椎管内渗漏率差异无显著性意义。所有骨水泥渗漏患者均无明显临床不适症状；③结果说明：应用高黏度及低黏度骨水泥行椎体成形均可显著改善骨质疏松椎体压缩性骨折患者的生活质量和减轻疼痛，且高黏度骨水泥骨水泥总渗漏率和椎间盘渗漏率较低。

BACKGROUND： Percutaneous vertebropiasty is a widely used vertebral augmentation procedure for treating osteoporotic vertebral compression fractures, but high leakage rate of the cement has limited its general use. How to avoid or reduce the leakage of cement becomes the host spot in the field of research. OBJECTIVE： To compare the safety and efficacy of high-viscosity cement and low-viscosity cement in percutaneous vertebroplasty. METHODS： 107 vertebrae in 92 consecutive patients who underwent percutaneous vertebroplasty for osteoporotic vertebral compression fractures were divided into the high-viscosity group （high-viscosity bone cement, 48 patients, 56 vertebrae） and the low-viscosity group （low-viscosity bone cement, 44 patients, 51 vertebrae）. High-viscosity group used the PALACOS^R＋G high-viscosity bone cement, but low-viscosity group used the OSTEOPALCV low-viscosity bone cement. RESULTS AND CONCLUSION： （1） Visual Analog Scale and Oswestry Disability Index were improved significantly in both groups at 3 days postoperatively. No significant difference was found between the two groups. （2） The incidence of cement leakage in the high-viscosity group was lower than that of low-viscosity group, and there was significantly less leakage into disc space with the high-viscosity cements versus low-viscosity cements, but the proportion of leakage into epidural space, paravertebral area, peripheral vein were not significantly different between the high-viscosity and low-viscosity groups. No symptomatic cement leakages occurred in both groups. （3） Results indicated that percutaneous vertebroplasty with both high-viscosity cement and high-viscosity cement is safe and effective in improving quality of life and relieving pain. High-viscosity cement has a lower cement leakage rate and leakage into disc space rate in percutaneous vertebroplasty.