骨水泥的弥散情况对经皮椎体成形的疗效影响

The Effect of Distribution of Bone Cement on the Outcome of Percutaneous Vertebroplasty

目的:探讨经皮椎体成形术(PVP)中骨水泥在椎体骨折线内的弥散情况对临床疗效的影响。方法:回顾性研究2012年1月至2016年8月因骨质疏松性椎体压缩骨折(OVCF)在本院住院行单节段PVP治疗的患者57例。根据骨水泥在椎体骨折线内的弥散情况分为A组(27例):骨水泥在骨折线内充分弥散,B组(30例):骨水泥在骨折线内弥散不佳。将两组间的术前、术后3d及末次随访时的VAS评分及JOA评分及后凸Cobb角等指标进行对比分析。结果:两组患者术后3d的VAS评分及JOA评分及后凸Cobb角均较术前明显改善,差异有统计学意义(P<0.05),A组的VAS评分及JOA评分改善程度优于B组,差异有统计学意义(P<0.05),A组后凸cobb角纠正丢失量显著小于B组,差异有统计学意义(P<0.05),A组术椎再塌陷率为7.4%(2/27),B组术椎再塌陷率为36.7%(11/30),差异具有统计学意义(P<0.05)。结论:PVP中骨水泥在椎体骨折线内弥散不佳会影响手术的近期疗效,也可能是导致PVP术后出现术椎再塌陷的危险因素。

Objective：To investigate the effect of the distribution of bone cement in the vertebral fracture line in percutaneous vertebroplasty（PVP）.Methods：Retrospective study of 57 patients with single-segment PVP in our hospital due to osteoporotic vertebral compression fracture（OVCF）was performed from January 2012 to August 2016.According to the distribution of bone cement in the vertebral fracture line,it was divided into group A（27 cases）：bone cement was well dispersed within the fracture line,and group B（30 cases）：bone cement was not well dispersed within the fracture line.The VAS scores,JOA scores and kyphotic Cobb angles were compared between the two groups before and 3 days after surgery and at the last follow-up.Results：The VAS score,JOA score and kyphotic Cobb angle were significantly improved.The improvement of VAS score and JOA score was better in group A than those in group B（P〈0.05）.The loss of Cobb angle of group A was significantly less than that of group B（P〈0.05）.The collapse rate was 7.4%（2/27）in group A and 36.7%（11/30）in group B.The difference between the two groups was statistically significant（P〈0.05）.Conclusions：The poor distribution of cement in PVP in the vertebral fracture line may affect the short-term efficacy of surgery,and may also be a risk factor for PVP recurrence after operation.