应用两种骨水泥治疗骨质疏松性椎体压缩骨折的骨密度差异

Difference of Bone Mineral Density between Two Kinds of Bone Cement in Treating Osteoporotic Vertebral Compressed Fractures

目的:分析复合重组人骨形态发生蛋白2的磷酸钙骨水泥与单独磷酸钙骨水泥治疗骨质疏松性椎体压缩骨折的骨密度差异。方法:选取骨质疏松性椎体压缩骨折患者132例,其中68例患者采用磷酸钙骨水泥(磷酸钙组)治疗,另64例采用复合重组人骨形态发生蛋白的2磷酸钙骨水泥(磷酸钙联合生长因子组)治疗。术后7 d,门诊随访观察临床疗效;术前及术后3个月和6个月,采用双能X线骨密度仪检测伤椎骨密度及屏蔽填充物注射区伤椎骨密度;术前、术后7 d、术后3个月及末次随访时,用目测类比评分评估患者腰背部疼痛情况,采用Oswestry功能障碍指数评估脊柱功能,X线观察伤椎椎体前缘高度及后凸角。结果:两种治疗方式均取得了良好的治疗效果,总治疗有效率差异无统计学意义(P>0.05);末次随访时,磷酸钙联合生长因子组临近椎体骨折发生明显少于磷酸钙组,差异有统计学意义(P<0.05);术后6个月,磷酸钙联合生长因子组骨密度值明显高于术前及磷酸钙组,差异有统计学意义(P<0.05);两组术后不同时间点的疼痛、脊柱功能均较术前明显改善,差异有统计学意义(P<0.05),两组间比较差异无统计学意义(P>0.05);两组术后不同时间点的伤椎椎体前缘高度及后凸角均较术前明显改善,差异有统计学意义(P<0.05),两组间比较差异无统计学意义(P>0.05)。结论:对比单独磷酸钙骨水泥,复合重组人骨形态发生蛋白2的磷酸钙骨水泥治疗骨质疏松性椎体压缩骨折可提高骨密度,阻止邻近椎体发生骨折。

Objective:Comparison of bone mineral density difference between compound recombinant human bone morphogenetic protein 2 calcium phosphate cement and calcium phosphate cement alone in treating of osteoporotic vertebral compressed fractures(OVCF).Methods:132 patients with OVCF were enrolled,68 patients underwent treatment with calcium phosphate cement combined(calcium phosphate group),and 64 patients with compound recombinant human bone morphogenetic protein 2 calcium phosphate cement combined.Outpatient follow-up was conducted to observe the clinical efficacy 7 d after operation.Dual-energy X-ray bone mineral density instrument was used to measure the bone mineral density of injured vertebrae and the bone mineral density of injured vertebrae in the injection area of shielding filler before,3 and 6 months after operation.Visual Analogy Score(VAS)was used to evaluate the lumbar and back pain of patients,and Oswestry Disability Index was used to evaluate spinal function,and X-ray was used to observe the height and kyphosis angle of the vertebral body at all follow-up.Results:There was no significant difference in the total effective rate between the two groups(P>0.05).At the last follow-up,the incidence of adjacent vertebral fracture in calcium phosphate combined with growth factor group was significantly less than that in calcium phosphate group(P<0.05).The bone mineral density value of calcium phosphate combined with growth factor group was significantly higher than that of preoperative and calcium phosphate group 6 months later(P<0.05).The pain and spinal function of two groups at different time points after operation were significantly improved compared with those before operation(P<0.05),and there was no significant difference between the two groups.The anterior height and kyphosis angle of injured vertebral body at different time points after operation were both higher than those before operation.Conclusion:Compared with calcium phosphate cement alone,calcium phosphate cement combined with recombinant human bone morphogenetic protein 2 can improve bone mineral density and prevent adjacent vertebral fractures in treating OVCF.