高黏度骨水泥治疗骨质疏松性椎体压缩骨折的疗效观察

The utilization of high viscosity bone cement in percutaneous vertebroplasty for osteoporotic vertebral compression fractures: observation of its curative effect

目的观察高黏度骨水泥经皮椎体成形术(PVP)治疗骨质疏松性椎体压缩骨折的临床疗效。方法选择骨质疏松性椎体压缩骨折患者80例随机分为两组,每组40例,均行PVP手术治疗,研究组给予高黏度骨水泥,对照组给予低黏度骨水泥,术后3 d内CT复查观察椎体内骨水泥分布和椎旁渗漏情况。用疼痛视觉模拟评分(VAS)和日常生活活动能力评分(Barthel)评价两组疗效。比较两组骨水泥注入量、渗漏情况、手术费用和术中X线曝光时间。结果 80例患者PVP操作均成功,术前、术后24 h、术后第7天VAS和Barthel评分两组间比较差异均无统计学意义(P>0.05),同组患者PVP前后比较差异则有统计学意义(P<0.05)。骨水泥平均注入量:研究组4.60 ml,对照组4.41 ml(P>0.05);X线曝光时间:研究组4.17 min,对照组3.93 min(P>0.05);骨水泥渗漏:研究组4节段,对照组12节段(P<0.05);手术费用:研究组26 132元/节段,对照组925 1.5元/节段(P<0.01),研究组平均多耗费16 881元/节段。结论采用高黏度和低黏度骨水泥治疗骨质疏松性椎体压缩骨折都能迅速减轻患者腰背部疼痛,提高日常生活活动能力。高黏度骨水泥可减少渗漏,但价格偏高。

Objective To evaluate the clinical efficacy of percutaneous vertebroplasty using high viscosity bone cement in treating osteoporotic vertebral compression fractures. Methods A total of 80 patients with osteoporotic vertebral compression fractures were randomly divided into the study group and the control group with 40 patients in each group. Percutaneous vertebroplasty （PVP） was performed in all patients. High viscosity bone cement was used in the study group and low viscosity bone cement was adopted in the control group. Within 3 days after PVP, follow-up CT examination was conducted to check the bone cement distribution in vertebrae and to observe if there was any cement leakage at paravertebral region. The curative effect was evaluated by using daily life activities ability score （Barthel） and visual analogue scale （VAS）. The usage amount of bone cement, the cement leakage, the operation cost and the intraoperative X-ray exposure time of the two groups were statistically compared. Results PVP was successfully performed in all 80 patients. No statistically significant differences in VAS and Barthel scores determined at 24 hours and 7 days after PVP existed between the two groups （P〉0.05）. The postoperative VAS and Barthel scores were significantly different from the preoperative ones in the study group as well as in the control group （P〈0.05）. The average injection volumes of bone cement in the study group and in the control group were 4.60 ml and 4.41 ml respectively （/9〉0.05）. The mean intraoperative X-ray exposure time for each vertebral body was 4.17 minutes in the study group and was 3.93 minutes in the control group （P〉0.05）. Bone cement leakage was observed in 4 vertebrae of the study group and in 12 vertebrae of the control group （P〈0.05）. The operation cost for each vertebra was 26,132 RMB in the study group and was 9,251.5 RMB in the control group （P〈 0.01 ）. The study group cost 16,881 RMB more than the control group for one vertebra. Conclusion PVP for osteoporotic vertebral compression fractures, regardless of using high viscosity bone cement or using low viscosity bone cement, can rapidly relieve patient＇s back pain and improve the ability of daily living activities. The use of high viscosity bone cement can effectively reduce the occurrence of cement leakage, but its medical expense is high.