不同黏度骨水泥椎体成形术治疗重度骨质疏松性骨折的疗效研究

A Comparison of High Viscosity Bone Cement and Low Viscosity Bone Cement Vertebroplasty for Severe Osteoporotic Vertebral Compression Fractures

目的对重度骨质疏松性胸腰椎骨折患者,采用高黏度骨水泥及普通黏度骨水泥行椎体成形术手术治疗,比较两组临床效果及并发症发生情况。方法对2010年12月至2012年12月入住本院的确诊为重度骨质疏松性胸腰椎骨折,具备椎体成形术手术指证且患者本人同意行椎体成形术治疗的32例病例,随机分为高黏度骨水泥组(14例)及普通骨水泥组(18例),手术前后采用视觉模拟评分(visual analogue scale,VAS)评估腰背部疼痛、Oswestry功能障碍指数(oswestry disability index,ODI)评估腰背部功能、SF-36健康调查评分评估生活质量,影像学测量伤椎椎体高度、伤椎后凸畸形角度等参数,同时观察骨水泥渗漏、肺栓塞、邻近椎体骨折等并发症发生情况。结果两组患者术前一般情况比较差异无统计学意义。所有患者均顺利完成手术,至少完成18个月随访,平均随访时间24.5个月,随访期间未出现邻近椎体新发骨折。两组在每个椎体手术时间、骨水泥注射量方面比较,差异无统计学意义(P>0.05)。高黏度骨水泥组17个椎体中,经单侧穿刺4个(23.5%),经双侧穿刺13个(76.5%),普通骨水泥组22个椎体中,经单侧穿刺6个(27.3%),经双侧穿刺16个(72.7%),两组比较差异无统计学意义(P>0.05)。两组所有患者疼痛症状均明显缓解,VAS评分明显降低,ODI评分明显降低,SF-36评分明显改善,伤椎椎体前缘高度及伤椎椎体中部高度明显改善,后凸畸形角度明显改善,以上所有指标手术前后差异均有统计学意义(P<0.05),但两组差异无统计学意义(P>0.05)。术后CT发现骨水泥渗漏高黏度骨水泥组5个椎体(29.4%),普通骨水泥组15个椎体(68.2%),均无特殊不适及神经症状,但两组比较差异有统计学意义(P<0.05)。结论采用高黏度骨水泥对重度骨质疏松性胸腰椎骨折行椎体成形术治疗在技术上是可行的,可以达到与普通骨水泥椎体成形术相同的临床效果,但可显著减少术后骨水泥渗漏的发生,提高手术安全性。

Objective To compare the clinical outcome and complications of high viscosity and low viscosity poly-methyl methacrylate（ PMMA） bone cement percutaneous vertebroplasty（ PVP） for severe osteoporotic vertebral compression fractures（ OVCFs）. Methods From December 2010 to December 2012,32 patients with severe OVCFs were randomly assigned to the group H using high viscosity cement（ n = 14） or group L using low viscosity cement（ n = 18）. The clinical outcomes were assessed by the Visual Analogue Scale（ VAS）,Oswestry Disability Index（ ODI）,Short Form-36 General Health Survey（ SF-36）,kyphosis Cobb＇s angle,vertebral height,and complications. Results There were no significant differences between group H and group L in the gender ratios,age and involved vertebral bodies. Mean follow-up was 24. 5 months（ range,18 ~ 42months）. No significant clinical complications or post-procedural clinical sequelae or new adjacent vertebral fractures were found. There was no statistical difference between the two groups according to the average surgery time,vertebrae and average injected cement volume,vertebrae（P〈0. 05）. Of the 17 vertebrae in the group H,PVP was unipedicular in 4（ 23. 5%） cases and bipedicular in 1 3（ 7 6. 5 %）,whereas the procedure was unipedicular in 6（ 2 7. 3 %） cases and bipedicular in 1 6（ 72. 7%） of 22 vertebrae in the group H,with no statistical difference（P〈0. 05）. Significant improvement on the VAS,ODI,SF-36 scores,kyphosis Cobb＇s angle and vertebral height were noted in each group,and there were no significant differences between the 2 groups. Cement leakage was less in group H. Postoperative CT assessment identified cement leakage in 5 of 17 vertebraes in the group H（ 29. 4%） and in 15 of 22 vertebraes（ 68. 2%） in group L（P〈0. 05）. All leakages were clinically silent and no neural compromise or pulmonary embolism was found. Conclusion The PVP using high viscosity bone cement can get the same clinical outcome and fewer complications compared with PVP using low viscosity bone cement.