高粘度骨水泥后凸成形术治疗骨质疏松性胸腰椎骨折

High-viscosity bone cement used in percutaneous kyphoplasty for osteoporotic thoracolumbar fractures

[目的]探讨高粘度骨水泥在骨质疏松性胸腰椎骨折经皮椎体后凸成形术(PKP)的临床效果。[方法]回顾性分析2015年1月~2018年1月本院接受PKP的95例骨质疏松性胸腰椎骨折患者,依据医患沟通分为两组,高粘度组50例和低粘度组45例。比较两组围术期、随访、骨密度和影像资料。[结果]两组均顺利完成手术,术中血压、血氧饱和度等均正常,无严重并发症发生。高粘度组透视次数明显少于低粘度组,差异有统计学意义(P<0.05)。两组患者随访12个月以上,两组患者术后VAS和ODI评分均较术前显著减少(P<0.05)。术后12个月,高粘度组的VAS和ODI评分显著小于低粘度组,差异有统计学意义(P<0.05)。术后两组患者的腰椎骨密度均较术前显著增加(P<0.05),12个月时高粘度组腰椎骨密度显著大于低粘度组(P<0.05)。影像方面,高粘度组骨水泥渗漏为6.00%,而低粘度组为20.00%;两组差异有统计学意义(P<0.05))。术后12个月与术前相比较,两组的椎体前缘高度、椎体中线高度均显著增加(P<0.05),而Cobb角显著减小(P<0.05)。术后12个月时,高粘度组椎体前缘高度、椎体中线高度和Cobb角均显著优于低粘度组(P<0.05)。[结论]高粘度骨水泥PKP治疗骨质疏松性胸腰椎骨折临床效果优于低粘度骨水泥,且减少骨水泥渗漏率。

[Objective] To evaluate the clinical outcomes of high-viscosity bone cement used in percutaneous kyphoplasty(PKP) for osteoporotic thoracolumbar fractures. [Methods] A retrospective study was conducted on 95 patients who underwent PKP for osteoporotic thoracolumbar fractures in our hospital from January 2015 to January 2018. In term of the viscosity of bone cement injected in PKP, 50 patients received PKP with high-viscosity bone cement(HVBC), while the remaining 45 patients had PKP performed with low-viscosity bone cement(LVBC). The perioperative data, follow-up documentation, bone mineral density(BMD) and radiographs were compared between the two groups. [Results] The patients in both groups underwent operations successfully with stable blood pressure and oxygen saturation in normal level, whereas with no serious complications. The patients in the HVBC group received significantly less X-ray exposure during operation than those in the LVBC group(P<0.05). As time went in the follow-up period more than 12 months, the VAS and ODI scores significantly decreased in both groups(P<0.05), and the HVBC group was of significantly lower VAS and ODI scores than the LVBC group at 12 months postoperatively(P<0.05). In addition, the BMD of the affected vertebrae significantly enhanced at 12 months after operation in both groups compared with those before operation(P<0.05), with significantly higher BMD in the HVBC group than the LVBC group at 12 months postoperatively(P<0.05). Regarding to radiographic assessment, the rate of bone cement leakage proved 6.00% in the HVBC group, whereas 20.00% in the LVBC group, which was of statistical significance(P<0.05). The anterior vertebral height and middle vertebral height significantly increased, while the Cobb’s angle significantly decreased in both groups at 12 months after operation in comparison to those before operation(P<0.05). The HVBC group was significantly superior to the LVBC group at 12 months postoperatively regarding to aforesaid items(P<0.05). [Conclusion] In this study the high-viscosity bone cement has a benefit of reducing risk of bone cement leakagein PKP, and achieves better clinical outcomes than the low-viscosity bone cement for osteoporotic thoracolumbar fractures.