不同黏度大剂量骨水泥在经皮椎体成形中的应用疗效与并发症

Efficacy and complications of different viscosities of high-dose bone cement applied in percutaneous vertebroplasty

背景:虽然经皮椎体成形已被广泛用于老年疼痛性骨质疏松性椎体压缩骨折的治疗,但是关于骨水泥合理剂量和选择的相关研究仍不充分,尚未有统一结论。目的:对比不同黏度大剂量骨水泥在经皮椎体成形治疗老年骨质疏松性椎体压缩骨折中的疗效和并发症发生情况。方法:选择2014年2月至2018年12月上海交通大学医学院附属第九人民医院收治的单节段老年胸腰段(T12-L2)骨质疏松性骨折患者169例,其中85例进行大剂量低黏度骨水泥椎体成形治疗(对照组),84例进行大剂量高黏度骨水泥椎体成形治疗(观察组),两组骨水泥注射剂量均>4 mL。术前及术后2 d,记录两组目测类比评分、伤椎前缘高度、伤椎Cobb角及骨水泥渗漏情况。研究方案经上海交通大学医学院附属第九人民医院伦理委员会批准(批准号SH9H-2019-T90-1)。结果与结论:①两组术后2 d的目测类比评分均较术前明显下降(P<0.05),两组组间比较差异无显著性意义(P>0.05);②两组术后2d的伤椎前缘高度均较术前升高(P<0.05),两组组间比较差异无显著性意义(P>0.05);③两组术后2 d的伤椎Cobb角均较术前减少(P<0.05),两组组间比较差异无显著性意义(P>0.05);④对照组85例中57例(67.1%)发生骨水泥渗漏,观察组84例中36例(42.9%)发生骨水泥渗漏,两组组间比较差异有显著性意义(P<0.05),并且观察组椎旁血管、椎管内骨水泥渗漏发生率低于对照组(P<0.05);⑤两组均未出现植入物周围感染、过敏反应、免疫反应及排斥反应;⑥结果表明,应用大剂量的高、低黏度骨水泥治疗老年骨质疏松性椎体骨折均可取得良好的临床疗效,但低黏度骨水泥的渗漏发生率较高,高黏度骨水泥可显著降低渗漏风险,尤其是椎旁血管和椎管内的渗漏率。

BACKGROUND: Percutaneous vertebroplasty has been extensively applied in the treatment of senile osteoporotic vertebral compression fracture with pain. However, the appropriate dose of bone cement remains controversial. OBJECTIVE: To compare the efficacy and complications of different viscosities of high-dose bone cement applied in the treatment of osteoporotic vertebral compression fractures by percutaneous vertebroplasty. METHODS: One hundred and sixty-nine patients with single-segment osteoporotic fractures at thoracolumbar level(T12-L2) admitted at Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine from February 2014 to December 2018 were included. All patients were treated by percutaneous vertebroplasty with high-dose(> 4 mL) bone cement at low viscosity(n=85, control group) and high viscosity(n=84, observation group). The Visual Analogue Scale score, anterior vertebral height, Cobb angle and bone cement leakage were recorded before and 2 days after surgery. The study was approved by the Medical Ethics Committee of Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, China(approval No. SH9 H-2019-T90-1). RESULTS AND CONCLUSION:(1) The Visual Analogue Scale score at postoperative 2 days in both groups were significantly lower than that at baseline(P < 0.05), and there was no significant difference between the observation and control groups(P > 0.05).(2) The anterior vertebral height at postoperative 2 days in both groups was significantly higher than that at baseline(P < 0.05), and there was no significant difference between two groups(P > 0.05).(3) Compared with the baseline level, the Cobb angle at postoperative 2 days in both groups was significantly decreased(P < 0.05), and there was no significant difference between two groups(P > 0.05).(4) The incidence of bone cement leakage in the observation group(36/84, 42.9%) was significantly lower than that in the control group(57/85, 67.1%)(P < 0.05). The incidence of leakage in paravertebral vessels and spinal canal in the observation group was significantly lower than that in the control group(P < 0.05).(5) Peri-implant infection, allergic reaction, immune and rejection reactions occurred in neither groups.(6) These results indicate that treatment of senile osteoporotic vertebral compression fractures with high dose of low-and high-viscosity bone cement can result in good clinical outcomes. However, the incidence of leakage is higher in the low-viscosity bone cement, and high-viscosity bone cement can significantly reduce the risk of leakage, especially the leakage of paravertebral blood vessels and spinal canal.