骨质疏松性椎体压缩性骨折患者椎体成形术后骨折线附近骨水泥分布情况对疗效的影响

Effect of bone cement distribution near the fracture line after percutaneous vertebroplasty on patients with osteoporotic vertebral compression fractures

目的探讨骨质疏松性椎体压缩性骨折（over）患者经皮椎体成形术（PVP）治疗后，骨水泥在骨折线附近的分布情况对临床疗效的影响。方法选取2015年9月至2017年8月行PVP治疗的OVCF患者120例，术前通过磁共振抑脂成像确定骨折线的范围，应用计算机辅助设计软件进行三维建模。PVP术后行CT骨水泥三维成像，根据骨水泥在骨折线附近的分布情况将患者分为两组，骨水泥在骨折线区域分布不佳52例（A组），骨水泥在骨折线附件分布良好68例（B组）。分别于术前、术后第2天和术后3个月进行疼痛视觉模拟评分（VAS）和Oswestry功能障碍指数（ODI）测评。结果所有患者均顺利完成手术，术后疼痛明显缓解。A组有3例发生术后骨水泥泄漏，B组有4例，患者均无明显临床症状，无神经损伤、感染等严重并发症出现。A组和B组骨水泥用量比较差异无统计学意义[（4．08±0．74）ml比（4．03±1．03）ml，P〉0．05]。两组术前VAS和ODI比较差异无统计学意义（P〉0．05）。两组术后第2天和术后3个月VAS和ODI明显低于术前[VAS：（4．54±．0．81）和（1．46±0．51）分比（7．38±0．94）分、（2．68±0．88）和（1．18±0．58）分比（7．21±1．12）分，ODI：（70．23±2．70）和（19．42±2．21）分比（90．46±1．79）分、（48．85±2．23）和（18．85±1．84）分比（90．50±2．02）分]，差异有统计学意义（P〈0．05）；B组术后第2天VAS和ODI明显低于A组，差异有统计学意义（P〈0．01）；两组术后3个月VAS和ODI比较差异无统计学意义（P〉0．05）。结论PVP可明显缓解OVCF患者的疼痛，骨水泥在骨折线附近分布良好患者早期效果明显。

Objective To investigate the effect of bone cement distribution near fracture line after percutaneous vertebroplasty （PVP） on patients with osteoporotic vertebral compression fractures （OVCF）. Methods One hundred and twenty OVCF patients who had underwent PVP from September 2015 to August 2017 were selected. The range of fracture line was determined by magnetic resonance lipid suppressor sequence imaging before operation, and the three-dimensional modeling was carried out by computer aided design software. Three dimensional imaging of CT bone cement was performed after PVP. The patients were divided into 2 groups according to the bone cement distribution near fracture line. The bone cement distribution near fracture line area was not good in 52 cases （group A）, and the bone cement distribution near fracture line was good in 68 cases （group B）. The pain visual analogue score （VAS） and the Oswestry dysfunction index （ODI） were measured before operation, second day after operation and 3 months after operation. Results All the patients completed the operation successfully, and the postoperative pain was significantly relieved. In group A, there were 3 cases of with postoperative bone cement leakage, and 4 cases in group B. There were no obvious clinical symptoms, no serious complications such as nerve injury and infection. There was no significant difference in the amount of bone cement between group A and group B： （4.08 ± 0.74） ml vs. （4.03 ± 1.03） ml, P 〉 0.05. There were no significant differences in VAS and ODI before operation between 2 groups （P 〉 0.05）. The VAS and ODI second day and 3 months after operation were significantly lower than those before operation in 2 groups, VAS： （4.54 ± 0.81） and （1.46 ± 0.51） scores vs. （7.38 ± 0.94） scores, （2.68 ± 0.88） and （1.18 ± 0.58） scores vs. （7.21 ± 1.12） scores; ODI： （70.23 ± 2.70） and （19.42 ± 2.21） scores vs. （90.46 ± 1.79） scores, （48.85 ± 2.23） and （18.85 ± 1.84） scores vs. （90.50± 2.02） scores, and there were statistical differences （P 〈 0.05）. The VAS and ODI second day after operation in group B were significantly lower than those in group A, and there were statistical differences （P 〈 0.01）. There were no significant differences in VAS and ODI 3 months after operation between 2 groups （P 〉 0.05）. Conclusions PVP can obviously relieve the pain of OVCF patients. The bone cement is well distributed near the fracture line, and the early effect is obvious.