高黏度骨水泥弥散程度对老年女性骨质疏松椎体压缩性骨折治疗效果的影响

Effect of high-viscosity cement dispersion on the treatment of osteoporotic vertebral compression fracture in elderly women

背景:高黏度骨水泥是在传统聚甲基丙烯酸甲酯的基础上改进得到,具有可注射时间长、黏度高、聚合温度低等特点,进一步增加了椎体成形手术的安全性。目的:分析椎体成形治疗老年女性骨质疏松椎体压缩性骨折中高黏度骨水泥弥散程度对临床疗效的影响。方法:纳入120例女性首次、单一节段骨质疏松椎体压缩性骨折患者,年龄53-83岁,均进行高黏度骨水泥椎体成形手术。根据术后侧位X射线片将骨水泥弥散至上下终板两侧的患者记为A组(n=54),其他患者记为B组(n=66);根据CT横断位骨水泥弥散情况,将A组中均匀弥散至双侧椎弓根的患者记为Ⅰ度,其他患者记为Ⅱ度。术后所有患者均随访6个月以上,对比各组末次随访的椎体前缘高度恢复率、局部后凸角改善率、目测类比评分与Oswestry功能障碍指数评分。结果与结论:(1)A组末次随访的椎体前缘高度恢复率、末次随访局部后凸角改善率均高于B组(P <0.05);(2)末次随访时,A、B组目测类比评分与Oswestry功能障碍指数评分均较治疗前明显改善(P <0.05),两组间比较差异无显著性意义(P> 0.05);(3)Ⅰ度组与Ⅱ度组末次随访的椎体前缘高度恢复率、局部后凸角改善率比较差异均无显著性意义(P> 0.05);(4)A组中骨水泥渗漏9例,术后发热4例,低血压2例;B组中骨水泥渗漏8例,发热6例,术后血压升高2例,术后皮肤浅层渗液1例,两组间不良反应发生情况比较差异无显著性意义(P> 0.05);(5)结果表明,高黏度骨水泥椎体成形治疗老年女性单节段骨质疏松椎体压缩性性骨折疗效肯定,骨水泥弥散程度愈高临床疗效愈佳,但高黏度骨水泥的注入要适量,过多的弥散会增加渗漏风险。

BACKGROUND:High-viscosity bone cement is modified on the basis of traditional polymethylmethacrylate with the long injection time,high-viscosity and low polymerized temperature feature and further improves the safety of percutaneous vertebroplasty.OBJECTIVE:To analyze the effect of high-viscosity bone cement dispersion on the clinical outcomes in elderly female patients with osteoporotic vertebral compression fracture who have undergone percutaneous vertebroplasty.METHODS:Totally120elderly female patients with primary single-segmental osteoporotic vertebral compression fracture aged from53to83years were included,and percutaneous vertebroplasty with high-viscosity bone cement was performed in all the enrolled patients.The patients were assigned into two groups according to the bone cement dispersion shown on the lateral X-ray film.The bone cement dispersed to both endplates in the fractured vertebral bodyof54patients,who were marked as group A,and the other66patients were classified as group B.The group A patients were further divided into two subgroups in term of CT cross-sectional image,and the patients with the bone cement dispersing to the bilateral pedicles were taken as degree I(25patients)and the others were termed as degree II(29patients).All patients were followed up for more than6months,and the recovery rate of anterior height of the vertebra,local kyphosis angle improvement rate,visual analog scale scores and Oswestry dysfunction index score at the last follow-up were compared among groups.RESULTS AND CONCLUSION:(1)The recovery rate of anterior height of the vertebra and local kyphosis angle improvement rate in group A were better than those in group B at the last follow-up(P<0.05).(2)The visual analog scale scores and Oswestry dysfunction index scores in both A and B groups were significantly improved at the last follow-up compared to the baseline data(P<0.05),but there was no significant difference between the two groups(P>0.05).(3)The subgroups of degree I and II showed no significant difference in the recovery rate of anterior height of the vertebra and local kyphosis angle improvement rate at the last follow-up(P>0.05).(4)There were nine patients with bone cement leakage,four patients with postoperative fever,two patients with low blood pressure in group A and eight patients with bone cement leakage,six patients with postoperative fever,two patients with high blood pressure,one patient with superficial skin infection in group B,but there was no significant difference in the postoperative complications between the two groups(P>0.05).All the results suggest that percutaneous vertebroplasty with high-viscosity bone cement has positive efficacy in treating elderly women with single-segmental osteoporotic vertebral compression fracture.The better dispersion of bone cement in the fractured vertebrae indicates the better clinical effects.However,high-viscosity bone cement should be injected in an appropriate amount,as excessive dispersion will increase the risk of leakage.