高粘度骨水泥经皮椎体成形术治疗严重骨质疏松性椎体压缩性骨折的临床对照研究

Clinical Control Study of High-viscosity Bone Cement Percutaneous Vertebroplasty for Severe Osteoporotic Vertebral Compression Fractures

目的探讨高粘度骨水泥经皮椎体成形术治疗严重骨质疏松性椎体压缩性骨折(OVCF)的临床疗效。方法方便选取2014年12月—2018年6月期间该院收治的120例严重OVCF患者,随机分为高粘度骨水泥组(n=60)和低粘度骨水泥组(n=60)。低粘度骨水泥组患者采用低粘度骨水泥经皮椎体成形术治疗,高粘度骨水泥组患者采用高粘度骨水泥经皮椎体成形术治疗。分析比较两组患者术前和术后1 d、1个月、6个月的VAS评分、ODI评分和Cobb角;记录两组随访期间的椎体高度恢复率、骨水泥注入量、骨水泥渗透率。结果手术前,两组患者的VAS评分[(7.20±0.63)分vs(7.18±0.59)分,t=0.180,P=0.858]、ODI评分[(73.26±6.20)分vs(72.94±6.51)分,t=0.276,P=0.783]和Cobb角[(26.30±5.61)°vs(26.41±4.53)°,t=0.118,P=0.906]均比较差异无统计学意义(P>0.05);术后1 d、1个月和6个月,两组患者的VAS评分、ODI评分和Cobb角持续降低,两组患者术后1 d[(3.14±0.46)分vs(3.48±0.59)分,t=3.520,P<0.001]、1个月[(1.88±0.41)vs(2.37±0.34)°,t=7.126,P<0.001]和术后6个月[(1.14±0.35)分vs(1.46±0.29)分,t=5.453,P<0.001]的VAS评分比较差异有统计学意义(P<0.05);术后1 d和术后1个月的ODI评分[(22.32±1.60)分vs(30.16±2.14)分,t=8.233,P<0.001;(8.16±1.43)vs(10.64±1.62)分,t=8.890,P<0.001)和Cobb角[(7.62±1.84)°vs(8.34±2.05)°,t=2.025,P=0.045;(7.74±1.67)°vs(8.50±2.02)°,t=2.246,P=0.027]比较差异有统计学意义(P<0.05);高粘度骨水泥组患者的椎体高度恢复率[(29.30±2.19)vs(26.16±3.62),t=5.749,P<0.001]和骨水泥渗透率(3.33%vs 13.33%,χ^2=3.927,P=0.048)高于低粘度骨水泥组(P<0.05);两组患者的骨水泥注入量比较差异无统计学意义[(4.69±0.47)vs(4.53±0.59),t=1.643,P=0.103]。结论高粘度骨水泥经皮椎体成形术治疗严重OVCF能有效缓解患者疼痛,纠正后凸Cobb角,并减少骨水泥渗漏的发生率,效果显著。

Objective To investigate the clinical efficacy of high-viscosity bone cement percutaneous vertebroplasty in the treatment of severe osteoporotic vertebral compression fracture (OVCF). Methods A total of 120 patients with severe OVCF admitted to our hospital from December 2014 to June 2018 were convenient divided into high-viscosity bone cement group (n=60) and low-viscosity bone cement group (n=60). Patients with low-viscosity bone cement were treated with low-viscosity bone cement percutaneous vertebroplasty, and patients with high-viscosity bone cement were treated with high-viscosity bone cement percutaneous vertebroplasty. The VAS score, ODI score and Cobb angle of the two groups before and after one day, one month and six months were analyzed and compared. The vertebral height recovery rate, bone cement injection volume and bone cement permeability were recorded during the two groups. Results Before surgery, the VAS scores of the two groups[(7.20±0.63)points vs (7.18±0.59)points, t=0.180, P=0.858), ODI score[(73.26±6.20)points vs (72.94±6.51)points, t=0.276, P=0.783] and Cobb angle [(26.30±5.61)° vs (26.41±4.53)°, t=0.118, P=0.906] were not statistically significant (P>0.05);VAS score, ODI score and scores of the two groups were one day, one month and six months after operation, Cobb angle continued to decrease, one day after surgery [(3.14±0.46)points vs (3.48±0.59)points, t=3.520, P<0.001], one month [(1.88±0.41)° vs (2.37±0.34)°, t=7.126, P<0.001] and surgery VAS scores of the last six months [(1.14±0.35)points vs (1.46±0.29)points, t=5.453, P<0.001] were statistically significant (P<0.05);ODI scores of one day after surgery and one month after surgery [(22.32±1.60) vs (30.16±2.14), t=8.233, P<0.001;(8.16±1.43) vs (10.64±1.62)points, t=8.890, P<0.001] and Cobb angle [(7.62±1.84)° vs (8.34±2.05)°, t=2.025, P=0.045;(7.74±1.67)°vs (8.50±2.02)°, t=2.246, P=0.027]The difference was statistically significant (P<0.05);the height recovery rate of vertebral body in patients with high viscosity bone cement group [(29.30±2.19) vs (26.16±3.62), t=5.749, P<0.001] and bone cement permeability (3.33% vs 13.33%, χ^2=3.927, P=0.048) were higher than those of low-viscosity bone cement group (P<0.05);there was no significant difference in bone cement injection between the two groups [4.69±0.47) vs (4.53±0.59), t=1.643, P=0.103]. Conclusion High-viscosity bone cement percutaneous vertebroplasty for severe OVCF can effectively relieve pain, correct kyphosis Cobb angle, and reduce the incidence of bone cement leakage.