高黏度骨水泥在单侧经皮椎体成形术中的弥散分布特点

The Diffusion Characteristics of High Viscosity Bone Cement in Unilateral Percutaneous Vertebroplasty

目的分析研究高黏度骨水泥在单侧经皮椎体成形术后的弥散分布特点,评价高黏度骨水泥在治疗骨质疏松性椎体压缩骨折的临床价值。方法前瞻性研究北京大学首钢医院2015年6月至2017年1月诊治的单椎体骨质疏松性压缩骨折病例76例,均应用高黏度骨水泥行单侧经皮椎体成形术,统计所有患者临床基本信息、骨水泥CT弥散分布、骨水泥终板分布、手术前后的视觉模拟评分、功能障碍指数、手术时间、伤椎椎体前缘高度及椎体后凸角(Cobb角)、骨水泥注入量、骨水泥渗漏情况等指标,运用SPSS 20.0进行统计学分析。结果所有患者术后的VAS评分、ODI、伤椎椎体前缘高度、椎体后凸角均较术前有显著改善(P<0.05);骨水泥椎体单侧弥散分布7例(9.2%)、双侧不对称弥散14例(18.4%)、双侧对称弥散患者55例(72.4%);同时骨水泥未弥散至终板的患者4例(5.3%),弥散至单侧终板18例(23.7%)、双侧终板54例(71.0%);骨水泥渗漏19例(25%)。结论高黏度骨水泥单侧PVP手术能有效缓解疼痛症状,使骨水泥对称的弥散至椎体前柱两侧以及椎体上下终板,恢复椎体高度,使伤椎均衡强化、获得更好的生物力学性能,增加伤椎刚度和强度,减少手术椎体再骨折风险,但并未增加骨水泥渗漏风险。

Objective To evaluate the clinical value of treatment of osteoporotic vertebral compression fractures with high viscosity bone cement percutaneous vertebroplasty.Methods This was a prospective study.76 patients with one-level OVCF were diagnosed and treated in Shougang Hospital of Peking University from June 2015 to January2017.All patients underwent unilateral percutaneous vertebroplasty with high viscosity bone cement.We collected data of basic clinical information,bone cement diffusion in the CT image,bone cement end plate diffusion in the X-ray,preoperative and postoperative VAS,ODI,operative time,the amount of bone cement injection,leakage of bone cement,preoperative and postoperative anterior vertebral height and kyphosis（Cobb angle）,and statistical analyzed the data with SPSS 20.0.Results There were a significant improvement of VAS scores,ODI,anterior vertebral height and kyphosis（P〈0.05）.In the CT image,there were only 7 cases（9.2%）unilateral diffusion,14 cases（18.4%）bilateral asymmetric diffusion,55 cases（72.4%）bilateral symmetrical diffusion.In the X-ray,the diffusion of no endplate,one end plate and both end plates were 4 cases（5.3%）,18 cases（23.7%）,54 cases（71.0%）,respectively.But there were 19 cases（25%）cement leakage.Conclusion Unilateral percutaneous vertebroplasty with high viscosity bone cement can significantly alleviate the pain of patients,lead to bone cement symmetrical diffuse to the both sides of vertebral anterior column and diffuse to both superior and interior of vertebral end plates,restore the height of the vertebral body,balanced intensify the fractured vertebral body to obtain better biomechanics,increase stiffness and strength the fractured vertebral body to reduce the risk of refracture,but this do not increase the risk of bone cement leakage.