经皮椎体成形术治疗骨质疏松性脊柱骨折的骨水泥弥散分布与临床疗效的相关研究

Correlation between the distribution of bone cement and clinical efficacy in the treatment of osteoporotic spinal fractures with percutaneous vertebroplasty

目的:探究经皮椎体成形术治疗骨质疏松性脊柱骨折的骨水泥弥散分布等级对临床效果及疼痛程度的影响。方法:回顾性分析自2016年8月至2018年4月收治的130例骨质疏松性脊柱骨折患者,其中114例资料完整完成随访。根据骨水泥弥散分布等级进行分组,统计分析患者术前及术后VAS评分、Oswestry功能障碍指数量表(ODI)、伤椎后凸角(Cobb角)、伤椎前柱高度变化及并发症。结果:114例术后随访6个月,骨水泥弥散分布等级:1级42例(36.8%),男14例,女28例,年龄(73.43±7.91)岁;2级36例(31.6%),男10例,女26例,年龄(71.22±8.06)岁;3级36例(31.6%),男9例,女27例,年龄(74.81±6.91)岁;4级0例(0%)。3组患者术前一般资料差异无统计学意义(P>0.05);骨水泥弥散分布等级1、2、3级患者,术后及术后1、3、6个月的随访中VAS、ODI评分均高于术前(P<0.05),3组间在术后随访的同一时间点差异无统计学意义(P>0.05)。在骨水泥渗漏方面,弥散分布等级2级15例(41.7%)、3级23例(63.9%),高于弥散分布1级8例(19%)(P<0.05)。在邻近椎体骨折方面,弥散分布等级2级7例(19.4%)、3级8例(22.2%),均低于1级18例(42.9%)。骨水泥弥散分布等级2、3级相比1级均能有效改善伤椎的后凸畸形和前柱高度丢失(P<0.05)。结论:经皮椎体成形术中骨水泥分散分布的不同等级均能有效缓解疼痛,且骨水泥弥散分布等级2级不仅能有效缓解患者疼痛、纠正伤椎后凸角、伤椎前柱高度,而且发生骨水泥渗漏及非手术椎体骨折的风险相对较低。

Objective:To investigate the effect of bone cement dispersion and distribution on the clinical effect and the degree of pain reduction of percutaneous vertebroplasty(PVP)in the treatment of osteoporosis spinal fracture.Methods:A retrospective analysis was made of 130 cases of osteoporotic spinal fractures admitted from August 2016 to April 2018,of which 114 cases were followed up completely.The VAS score,Oswestry disability index(ODI),kyphosis angle(Cobb angle),anterior column height and complications were analyzed.Results:Finally,114 cases were included.The grade of bone cement dispersion was 42 cases(36.8%)in grade 1,including 14 males and 28 females,with an average age of(73.43±7.91)years.There were 36 cases of grade 2(31.6%),including 10 males and 26 females with an average age of(71.22±8.06)years,and 36 cases with grade 3(31.6%),including 9 males and 27 females,with an average age of(74.81±6.91)years.There were no significant differences in preoperative general data among the three groups(P>0.05).The VAS,ODI score of grade 1,grade 2 and grade 3 of bone cement dispersion and distribution were significantly lower than those of preoperative follow-up(P<0.05)in the follow-up period of 1,1,3 and 6 months after operation(P<0.05).There were no significant differences between the three groups in using single factor ANOVA at the same time point of postoperative follow-up(P>0.05).In terms of bone cement leakage,15 cases(41.7%)were in grade 2 of diffusion distribution,23 cases(63.9%)in grade 3 more than 8 cases(19%)in grade 1 of diffusion distribution,exhibiting a significant difference among the three groups(P<0.05).The diffusive distribution in grade 2(7,19.4%)and grade 3(8,22.2%)less than that in grade 1(18,42.9%)(P<0.05).Bone cement dispersion and distribution with grade 2 and 3 level could effectively improve the kyphosis deformity and reduce the loss of anterior column height in the injured vertebrae compared with that with grade 1,showing a statistical difference among the three groups(P<0.05).Conclusion:Bone cement dispersion and distribution with any grades in PVP are effective in relieving pain,and bone cement dispersion and distribution with grade 2 could not only relieve the pain of patients,but also correct the kyphosis angle of the injured vertebrae.The height of the anterior column of the injured vertebrae and the risk of cement leakage and non-operative vertebral body fracture is relatively low.