经皮椎体后凸成形术注入高黏度骨水泥对疗效的影响

Effect of high viscosity bone cement in percutaneous kyphoplasty

目的观察经皮椎体后凸成形术(PKP)中应用高黏度骨水泥在伤椎内的分布和再骨折的风险。方法将100例行PKP治疗的椎体压缩性骨折患者分为两组,50例采用高黏度骨水泥(观察组),50例采用普通骨水泥(对照组)。术后定期门诊随访,观察疼痛VAS评分,测量椎体前缘高度及Cobb角,比较两组骨水泥弥散程度、邻近节段椎体再骨折率和不良反应发生情况。结果患者均获得12个月随访。观察组每个椎体骨水泥的注入量、配制时间均少于对照组(P<0.05)。术后第2天和6个月VAS评分两组均较术前降低(P<0.05),两组术后6个月评分较术后第2天进一步降低(P<0.05)。两组术后2 d及1、6、12个月椎体前缘高度均大于术前(P<0.05),术后各时间点组间、组内比较差异均无统计学意义(P>0.05)。两组术后2 d及1、6、12个月Cobb角均小于术前(P<0.05),术后各时间点组间、组内比较差异无统计学意义(P>0.05)。观察组骨水泥弥散程度优良率高于对照组(P<0.05)。观察组未发生骨水泥渗漏,1年内未出现邻近节段椎体骨折;对照组2例出现骨水泥渗漏,1年内发生邻近椎体骨折3例;两组并发症比较差异有统计学意义(P<0.05)。结论 PKP中应用高黏度骨水泥有助于缩短凝聚时间,提高弥散程度优良率,降低骨水泥渗漏发生率,同时降低邻近节段椎体再骨折风险。

Objective To investigate the distribution of the high viscosity bone cement in percutaneous kyphoplasty （ PKP） and the risk of refracture.Methods The 100 cases of vertebral compression fractures treated with PKP were divided into two groups.The 50 cases were treated with high viscosity bone cement injection （ observation group） and 50 cases were treated with ordinary bone cement injection （control group）.Postoperative follow-up regular out-pa-tient,the pain VAS,the anterior vertebral height and Cobb angle were measured.The degree of bone cement diffu-sion,the rate of adjacent vertebral body re-fracture and the incidence of adverse reactions were compared.Results All patients were followed up for 12 months.The injection volume and preparation time of each vertebral bone cement in the observation group were lower than those in the control group （P〈0.05）.The VAS of the second day and sixth months was lower than that before the operation （P〈0.05）,the VAS of 6 months postoperation was lower than 2 d postoperation （P〈0.05）.The anterior vertebrae height of the two groups at 2 d and 1,6,12 months was significantly higher than that of the two groups preoperation （ P〈0.05 ） .There was no significant difference between the two groups at each time point （P〉0.05）.The Cobb angles postoperation were smaller than those before operation （P〈0.05）,and there was no significant difference between the two groups at 2 d and 1,6,12 months after operation （P〉0.05）.The rate of bone cement dispersion in the observation group was higher than that of the control group （P〈0.05）.There was no complication of bone cement leakage in the observation group,and no adjacent vertebral fracture occurred in 1 year.In the control group,2 cases showed bone cement leakage,symptomatic treatment after remission,3 cases of adjacent vertebral fractures occurred adjacent to vertebral fracture in 1 year.The difference of complications between two groups was statistically significant（P〈0.05）.Conclusions The application of high vis-cosity bone cement in PKP can help to shorten the cohesion time,improve the degree of dispersion,reduce the inci-dence of bone cement leakage,while adjacent segmental vertebral fractures and low risk.