矿化胶原改性骨水泥椎体成形术治疗椎体压缩骨折的早期疗效

Early efficacy of bone cement modified with mineralized collagen in the treatment of vertebral compression fractures

目的探讨矿化胶原改性骨水泥椎体成形术(percutaneous vertebroplasty,PVP)治疗骨质疏松性椎体压缩骨折的早期疗效.方法 2017年6月至2018年8月单椎体骨质疏松性压缩骨折患者98例,PVP术中分别注入矿化胶原改性骨水泥48例(改性组)及传统骨水泥50例(传统组).统计所有患者的年龄、性别、骨密度等,比较两组术中骨水泥可推注时间、注入量、分布(骨水泥在椎体内呈整体团块,未出现中断或缺失,为"O"型;骨水泥在椎体内呈2个团块,中间有少量或无骨水泥,为"H"型)及其渗漏情况.疗效评价采用疼痛视觉模拟评分(visual analogue scale,VAS),Oswestry功能障碍指数(Oswestry disability index,ODI),伤椎前缘、中部、后缘高度及邻近椎体骨折发生率等,并进行统计分析.结果两组患者的年龄、性别、骨密度T值、骨水泥注入量的差异均无统计学意义.术后第1天及术后6个月随访时VSA评分、ODI、椎体前缘及中部高度较术前均明显改善,但两组间的差异均无统计学意义.术中骨水泥可推注时间,传统组少于改性组,两组的差异有统计学意义(t=3.428,P=0.002).传统组术后邻近椎体再骨折发生率为12%,改性组为2%,两组间的差异有统计学意义(χ^2=7.061,P=0.029).传统组术后骨水泥渗漏率为10%,改性组为6%,两组间的差异有统计学意义(χ^2=7.963,P=0.019).传统组骨水泥分布(O/H型)为20/30例,改性组为19/29例,两组间的差异有统计学意义(χ^2=38.992,P<0.001).结论改性骨水泥PVP治疗骨质疏松性椎体压缩骨折可以达到与传统骨水泥同样的止痛及恢复伤椎高度效果,但改性骨水泥术中可推注时间长,能明显降低骨水泥渗漏率及邻近椎体再骨折发生率.

Objective To investigate the early clinical efficacy of bone cement modified with mineralized collagen in the treatment of osteoporotic vertebral compression fractures with percutaneous vertebroplasty(PVP). Methods All 98 cases of single vertebral osteoporotic compression fracture from June 2017 to August 2018 were studied. Forty-eight cases were treated with bone cement modified with mineralized collagen (modified group) and 50 cases were treated with traditional bone cement (traditional group). The basic clinical information including age, sex and bone mineral density of all patients were analyzed. The injectable time, volume, distribution (bone cement in the vertebra showing a whole mass without interruption or loss is known as type O while bone cement in the vertebra showing two masses with a small amount or none in the middle is known as type H) and leakage of bone cement during operation, visual analogue score(VAS), Oswestry disability index (ODI), height of anterior, middle and posterior columns of injured vertebrae and the incidence of adjacent vertebral fractures were compared between the two groups. Results There were no significant differences in age, sex, bone mineral density T value and bone cement injection volume between the two groups. VSA score, ODI, anterior and middle column heights were significantly improved on the first day and 6 months after operation (P<0.05), but there was no significant difference between the two groups (P>0.05). Intraoperative cement injectable time was shorter in the traditional group than the modified group,and there was significant different between the two groups (t=3.428, P=0.002). The incidence of adjacent vertebral re-fracture was 12% in the traditional group and 2% in the modified group. There was significant different between the two groups (χ^2=7.061, P=0.029). The leakage rate of bone cement was 10% in the traditional group and 6% in the modified group, andthere was significant difference between the two groups (χ^2=7.963, P=0.019). The distribution of bone cement (O/H) in the traditional group was 20/30 and that in the modified group was 19/29, and there was significant difference between the two groups (χ^2=38.992, P<0.001). Conclusion Modified bone cement has the same clinical effect as traditional bone cement in relieving pain and restoring the height of injured vertebra in the treatment of osteoporotic vertebral compression fractures with PVP. However, the injectable time of modified bone cement is longer. The leakage rate and the incidence of re-fracture of adjacent vertebrae are significantly reduced.