椎体成形术中注入不同剂量骨水泥治疗骨质疏松性椎体压缩骨折的疗效分析

Effect analysis of different cement volume in percutaneous vertebroplasty for treatment of osteoporotic vertebral compression fractures

探讨经皮椎体成形术(PVP)注入不同剂量骨水泥治疗骨质疏松性椎体压缩骨折(OVCF)的有效性和安全性。方法自2015年6月至2017年1月,从首都医科大学附属北京友谊医院骨科随机挑选90例符合入选标准的OVCF患者,根据PVP术中骨水泥不同注入剂量,分为低剂量组(小于4 mL)、常规剂量组(4~6 mL)和高剂量组(大于6 mL),每组各30例,并对3组患者的手术时间、术中骨水泥用量、骨水泥渗漏,以及术前、术后1个月和术后1年的视觉模拟评分法(VAS)评分和Oswestry功能障碍指数(ODI)评分进行分析。对数据行单因素方差分析、Bonferroni校正法及χ^2检验。结果3组患者均顺利完成手术,无严重手术并发症的发生。(1)手术时间:低剂量组(22.30±2.71)min、常规剂量组(23.10±5.00)min,高剂量组(26.17±3.50)min,3组间总体比较差异有统计学意义(F=8.382,P=0.000),高剂量组的手术时间要明显高于前2组,差异均有统计学意义(P=0.001、0.008),而前2组的手术时间比较,差异无统计学意义(P>0.05)。(2)术中骨水泥用量:低剂量组(3.37±0.41)mL、常规剂量组(5.17±0.50)mL、高剂量组(6.53±0.64)mL,3组间总体比较差异有统计学意义(F=273.194,P=0.000)。(3)骨水泥渗漏:低剂量组8例、常规剂量组18例、高剂量组21例,高剂量组和常规剂量组骨水泥渗漏发生率明显高于低剂量组,差异有统计学意义(χ^2=6.787、11.279,P=0.027、0.003);而高剂量组和常规剂量组骨水泥渗漏发生率比较差异无统计学意义(χ^2=0.659,P=1.251)。(4)VAS评分:低剂量组、常规剂量组、高剂量组患者术前VAS评分分别为(8.70±1.21)、(8.50±1.17)、(8.17±1.12)分;术后1个月VAS评分分别为(3.37±1.03)、(3.83±1.23)、(3.47±1.11)分;术后1年VAS评分分别为(0.93±0.87)、(0.97±0.77)、(1.23±0.86)分。3组患者术后1个月和术后1年VAS评分明显小于术前,差异均有统计学意义(P值均小于0.05),但3组间总体比较差异均无统计学意义(P值均大于0.05)。(5)ODI评分:低剂量组、常规剂量组、高剂量组患者术前ODI评分分别为(41.20±2.43)、(40.83±2.20)、(39.93±2.08)分;术后1个月ODI评分分别为(23.07±2.70)、(23.17±2.95)、(22.80±3.20)分;术后1年ODI评分分别为(11.33±1.83)、(11.27±1.82)、(11.47±1.78)分。3组患者术后1个月和术后1年ODI评分明显小于术前,差异均有统计学意义(P值均小于0.05),但3组间总体比较差异均无统计学意义(P值均大于0.05)。结论PVP术中注入低剂量骨水泥可以达到同样良好的术后疼痛缓解以及功能恢复效果,可以明显缩短手术时间,降低骨水泥渗漏的风险。

Objective To investigate the efficacy and safety of percutaneous vertebroplasty(PVP)with different cement volume in the treatment of osteoporotic vertebral compression fractures(OVCF).Methods From June 2015 to January 2017,30 patients with thoracolumbar OVCF in the Department of Orthopedics,Beijing Friendship Hospital,Capital Medical University were randomly selected from low dose group(less than 4 mL),conventional dose group(4-6 mL)and high dose group(more than 6 mL)according to the different cement volume injected during PVP.The operation time,cement volume,cement leakage,visual analogue scale(VAS)score and oswestry disability index(ODI)score before operation,1 month after operation and 1 year after operation in the three groups were analyzed.Data were processed with one-way analysis of variance,Bonferroni correction,and chi-square test.Results All patients of 3 groups were treated by PVP successfully,without serious complications.(1)Operative time:low dose group:(22.30±2.71)minutes,routine dose group:(23.10±5.00)minutes,high dose group:(26.17±3.50)minutes,there was statistically significant difference among the three groups(F=8.382,P=0.000);the operation time of high dose group was significantly higher than that of low dose group and routine dose group,the differences are statistically significant(P=0.001,0.008),but there was no significant difference between low dose group and routine dose group(P>0.05).(2)The cement volume used during PVP:low dose group:(3.37±0.41)mL,routine dose group:(5.17±0.50)mL,high dose group:(6.53±0.64)mL,there were statistical differences among the 3 groups(F=273.194,P=0.000).(3)Bone cement leakage:low dose group:8 cases,routine dose group:18 cases,high dose group:21 cases.The incidence of bone cement leakage in routine dose group and high dose group was significantly higher than that in low dose group,the differences are statistically significant(χ^2=6.787,11.279,P=0.027,0.003).There was no significant difference in the incidence of bone cement leakage between routine dose group and high dose group(χ^2=0.659,P=1.251).(4)VAS scores:the preoperative VAS scores of the three groups were 8.70±1.21,8.50±1.17 and 8.17±1.12 respectively;the VAS scores of 1 month after operation were 3.37±1.03,3.83±1.23 and 3.47±1.11;the VAS scores of 1 year after operation were 0.93±0.87,0.97±0.77 and 1.23±0.86.VAS score of 3 groups within 1 month and 1 year after PVP were significantly lower than those preoperatively,the differences are statistically significant(with P values below 0.05),but there were no significant differences among the three groups(with P values above 0.05).(5)ODI scores:the preoperative ODI scores of the three groups were 41.20±2.43,40.83±2.20 and 39.93±2.08,respectively;the 1 month post-operative ODI scores were 23.07±2.70,23.17±2.95 and 22.80±3.20;and the 1 year post-operative ODI scores were 11.33±1.83,11.27±1.82 and 11.47±1.78.VAS score and ODI score of 3 groups within 1 month and 1 year after PVP were significantly lower than those preoperatively,the differences are statistically significant(with P values below 0.05),but there were no significant differences among the three groups(with P values above 0.05).Conclusion Low dose cement injected in PVP can achieve satisfied pain relief and functional recovery,and can significantly shorten the operation time and reduce the risk of cement leakage.