高黏度与低黏度骨水泥椎体成形术治疗骨质疏松椎体压缩性骨折的疗效观察

Effects of vertebroplasty with high- viscosity and low- viscosity bone cement in treatment of osteoporotic vertebral compression fractures

目的比较经皮椎体成形术（PVP）中使用高黏度聚甲基丙烯酸甲酯（PMMA）骨水泥和低黏度PMMA骨水泥治疗骨质疏松性椎体压缩性骨折（OVCF）的疗效，为日后临床PVP手术选择提供理论基础。方法对2014年1月至2015年1月期间行PVP治疗的158例OVCF患者进行回顾性研究。根据PVP术中使用的骨水泥黏度将患者分为高黏度组75例（A组）和低黏度组83例（B组）。采用视觉模拟量表（VAS）以及0swestry功能障碍指数（0DI）进行疼痛评分及脊椎功能评分，并比较两组患者骨水泥渗漏及邻近椎体骨折的发生情况。结果随访时间为12～18个月，平均随访时间为（14．3±3．6）个月。两组患者年龄、性别比、体质量指数（BMI）、BMD、VAS评分、ODI指数差异无统计学意义（P〉0．05）。术后3天及末次随访两组患者的VAS、ODI指数较术前降低（P〈0．05），术后3天及末次随访两组患者椎体高度较术前升高（P〈0．05）而两组间差异无统计学意义（P〉0．05）。A组渗漏率（9.3％）明显低于B组（25．3％）（P〈0．05）。A组邻近椎体骨折率（6．67％）与B组（4．82％）差异无统计学意义（P〉0．05）。两组均未发现其他并发症。结论高黏度及低黏度骨水泥均可有效治疗骨质疏松性椎体压缩性骨折，而使用高黏度骨水泥渗漏率明显低于低黏度骨水泥，在此方面更具优势。

Objective To compare the effect of percutaneous vertebroplasty （PVP） in the treatment of osteoporotic vertebral compression fractures （OVCF） by using high - viscosity polymethylmethaerylate （PMMA） cement and low-viscosity PMMA cement, and to provide theoretical basis for clinical PVP in the future. Methods The clinical data of 158 OVCF patients, who underwent PVP between January 2014 and January 2015, were retrospectively analyzed. According to the viscosity of the cement used in PVP, the patients were divided into high-viscosity group （n=75, group A） and low-viscosity group （n=83, group B）. The visual analogue scale （VAS） and Oswestry dysfunction index （ODI） were used to evaluate the pain scores and spine function scores, respectively. The incidences of bone cement leakage and adjacent vertebral fracture were compared between the two groups. Results The follow-up time ranged from 12 to 18 months with an average follow-up of （14.3~3.6） months. There were no statistically significant differences in age, sex ratio, body mass index （BMI） , bone mineral density （BMD） , VAS score and ODI between the two groups （P〉0.05）. The VAS and ODI at 3d after the operation and the last follow- up decreased in the two groups compared with those at the baseline （P〈0.05）. The height of vertebral body at 3d after the operation and the last follow-up increased in the two groups compared with that at the baseline （P〈0.05）. There were no statistically significant differences between the two groups （P〉0.05）. The leakage rate in group A （9.3%） was significantly lower than that in group B （25.3%） （P〈0.05）. There was no statistically significant difference in the rate of adjacent vertebral body fractures between group A （6.67%） and group B （4.82%） （P〉0.05）. No other complications were found in the two groups. Conclusion Both high-viscosity and low-viscosity bone cements are effective in treating OVCF. The leakage rate of using high-viscosity bone cement is significantly lower than that of using low-viscosity bone cement, which shows significantly advantages.