骨水泥在骨质疏松性椎体骨折线内弥散情况对椎体成形术疗效的影响

Effect of Bone Cement Diffusion in Osteoporotic Vertebral Fracture Line on Percutaneous Vertebroplasty

【目的】探讨骨水泥在骨质疏松性椎体骨折线内弥散情况对经皮椎体成形术（PVP）疗效的影响。【方法】选取2014年9月至2016年3月在广东省佛山市顺德区中医院治疗的骨质疏松性椎体压缩骨折（0steoporosis Vertehral Compression Fracture，OVCF）患者52例，均行PVP治疗，根据多平面重建CT或MRI评估情况分为骨水泥弥散良好患者39例（弥散良好组），弥散不佳患者13例（弥散不佳组），比较两组疼痛视觉模拟（VAS）评分、Oswestry功能障碍指数（ODI）及局部后凸Cobb角。【结果】弥散良好组骨密度为（-3．20±1．13）T，明显低于弥散不佳组（P〈0．05）；弥散良好组术后d。的VAS评分和0DI评分分别为（2．60±0．55）分和（12．82±1．41）分，明显低于弥散不佳组（P〈0．05）；两组术前及末次随访VAS评分及0DI比较差异无统计学意义（P〉0．05）；弥散良好组术后dt和末次随访局部后凸Cobb角分别为（6．30±2．11）°和（6．51±1．84）°，明显低于弥散不佳组（P〈0．05）；弥散良好组和弥散不佳组再骨折发生率分别为5．13％和7．69％，两组比较差异无统计学意义（P〉0．05）；弥散良好组椎体塌陷发生率为10．26％，明显低于弥散不佳组的38．46％，差异比较有统计学意义（P〈0．05）。【结论】PVP可改善OVCF患者功能障碍，而骨折线内骨水泥弥散不佳会影响近期疗效，可能导致术后后凸性畸形。

[Objective]To investigate the effect of bone cement diffusion in osteoporotic vertebral fractures line on percutaneous vertebroplasty （PVP）. [Methods]Fifty-two patients with osteoporotic vertebral compression fractures （OVCF） from September 2014 to March 2016 in our hospital were recruited in the research. All patients un derwent PVP treatment. According to multiplanar reconstruction CT or MRI evaluation, 39 cases were considered good dispersion of bone cement （good dispersion group）and 13 cases were considered poor dispersion of bone cement （ poor dispersion group）.Visual analogue scale （VAS） score, Oswestry disability index （ODD and local kyphosis Cobb angle were measured in the two groups. [Results]Bone mineral density of the good dispersion group was （-3.2± 1.13） T, which was significantly lower than that of the poor dispersion group （ P 〈0.05）. The VAS and ODI scores on d4 post-operation in the good dispersion group were （2.60±0.55） points and （12.82± 1.41） points, respectively, which were significantly lower than those in the poor dispersion group （ P 〈0.05）. There were no significant differences between the two groups in terms of VAS score and ODI score preoperatively and at the final follow-up after surgery （ P 〉0.05）.In the good dispersion group, local kyphosis Cobb angle on d4 post-operative and the final follow-up were （6.30±2.11）° and（6.51±1.84）° , respectively, which were significant- ly lower than those in the poor dispersion group （ P 〈0.05）. Refracture incidence rates in the good dispersion and poor dispersion group were 5.13% and 7.69%,respectively; the difference was not statistically significant （ P 〉0.05）; Vertebral collapse incidence rates inthe good dispersion group was 10.26%, which was significantly lower than that in the poor dispersion group （38.46%） ; the difference was statistically significant （ P 〈0.05）. [Conclu- sion]PVP can improve the function of patients with osteoporotic vertebral compression fractures. Poor dispersion of bone cement in the fracture line will affect the short-term efficacy, which may lead to postoperative kyphosis deformity.