椎体后凸成形术并发椎间隙骨水泥渗漏的临床研究

The Clinical Study of Intradiscal Cement Leakage after Percutaneous Kyphoplasty

目的研究椎体后凸成形术(percutaneous kyphoplasty,PKP)并发椎间隙骨水泥渗漏对相应的渗漏节段椎间盘退变及术后中期临床效果的影响。方法回顾性分析2009年3月至2014年9月辽阳市中心医院收治的188例胸腰椎骨质疏松压缩骨折患者,男32例,女156例;年龄62~78岁,平均年龄69.1岁;188例均采用PKP手术治疗,其中26例并发椎间隙骨水泥渗漏(研究组),162例无椎间隙骨水泥渗漏(对照组)。所有患者均获随访,平均随访时间25.2个月,椎间盘退变依据侧位片椎间盘前缘高度、后缘高度来评估;临床效果依据功能障碍指数(oswestry disability index,ODI)、视觉模拟评分(visual analogue scale,VAS)来评估。比较两组椎间盘高度变化及两组间ODI指数、VAS评分的差异。结果末次随访研究组的椎间盘前后缘高度分别是(5.65±2.21)mm、(2.94±0.89)mm;对照组的椎间盘前后缘高度分别是(7.36±2.43)mm、(3.77±1.84)mm。研究组比对照组椎间盘高度减低更显著(P<0.05)。术前两组ODI指数和VAS评分分别是(72.98±12.42)%、(7.50±1.05)分;(69.13±13.05)%、(7.44±0.97)分。术后1d两组ODI指数和VAS评分分别是(26.80±4.75)%、(2.45±0.63)分;(25.95±5.07)%、(2.47±0.77)分。末次随访时两组ODI指数和VAS评分分别是(31.12±3.58)%、(2.81±0.72)分;(29.75±4.32)%、(2.76±0.70)分。两组术后的ODI指数和VAS评分均较术前明显改善并持续到末次随访,两组间差异无统计学意义(P>0.05)。结论椎间隙骨水泥渗漏加速相应节段椎间盘退变的进程,但不影响PKP术后的中期临床效果。

Objective To study the effect of intradiscal cement leakage on the degeneration of cement-leaking discs and the interim clinical efficacy after percutaneous kyphoplasty（PKP）.Methods We retrospectively analyzed 188 cases of patients from March 2009 to September 2014 with the admittance to Liaoyang Central Hospital,diagnosed as thoracolumbar vertebral compression fractures,including 3 2 males and 1 5 6 females with average age of 6 9.1 years（range,62~78 years）.All were treated by PKP,classified into 26 cases with intradiscal cement leakage（Study Group）and 162 cases without cement leakage（control group）.All cases were followed with an average of 25.2 months.The degeneration of discs was assessed using anterior disc height and posterior disc height on standard lateral radiographs.Clinical efficacy was assessed using the Oswestry Disability Index scores（ODI）and Visual Analog Scale（VAS）.The changes of disc height and the ODI and VAS score were compared between the two groups.Results Anterior disc height and posterior disc height of Study Group at the last follow-up：（5.65±2.21）mm、（2.94±0.89）mm;Those of control group：（7.36±2.43）mm、（3.77±1.84）mm.The disc height of the study group was significantly lower than the control group（P〈0.05）.The ODI and VAS score of two groups before surgery：（72.98±12.42）%、（7.50±1.05）;（69.13±13.05）%、（7.44±0.97）.The ODI and VAS score of two groups one day after surgery：（26.80±4.75）%、（2.45±0.63）;（25.95±5.07）%、（2.47±0.77）.The ODI and VAS score of two groups at the last follow-up：（31.12±3.58）%、（2.81±0.72）;（29.75±4.32）%、（2.76±0.70）.The ODI and VAS score of two groups were significantly improved after operation and continued to the last follow-up,and there was no significant difference between the two groups（P〈0.05）.ConclusionIntradiscal cement leakage can accelerate the degeneration of the intervertebral disc,but it does not affect the interim clinical efficacy after PKP.