高黏度骨水泥PKP治疗胸腰椎重度骨质疏松性椎体压缩性骨折对术中弥散程度和术后再骨折的影响

Effect of high viscosity bone cement PKP on the degree of intraoperative dispersion and postoperative fracture in the treatment of severe osteoporotic vertebral compression fractures of the thoracolumbar spine

目的:高黏度骨水泥经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗胸腰椎重度骨质疏松性椎体压缩性骨折对术中弥散程度和术后再骨折的影响。方法:回顾性分析2016年2月至2019年4月行手术治疗的胸腰段椎体压缩性骨折患者78例,均行PKP治疗,39例采用高黏度骨水泥注入(观察组),39例采用普通骨水泥注入(对照组),术后随访0.5~1年。记录两组的VAS评分,手术前后摄X线及CT,测量椎体前、后缘高度、Cobb角,比较两组骨水泥弥散程度,并统计骨水泥渗漏率和邻近节段椎体再骨折率。结果:观察组骨水泥的注入量与对照组差异无统计学意义(P>0.05);观察组配制至注射时间少于对照组、手术时间长于对照组(P<0.05);伤椎前后缘高度、Cobb角在术前两组差异无统计学意义(P>0.05),术后两组Cobb角低于术前,伤椎前后缘高度高于术前,但观察组Cobb角更低,而伤椎前后缘高度更高(P<0.05);观察组骨水泥弥散I°百分比高于对照组(P<0.05);观察随访期间未出现邻近节段椎体骨折,对照组有5.13%(2/39)发生邻近椎体骨折(P<0.05);两组均未发生骨水泥渗漏;两组术后VAS评分均低于术前,对照组高于观察组(P<0.05),观察组降低幅度>对照组(P<0.05)。结论:对于骨质疏松性胸腰椎骨折患者,PKP术中应用高黏度骨水泥治疗可获得更好的弥散性,可有效恢复椎体高度和稳定性,提高力学性能,降低邻近节段椎体再骨折率,值得临床推广。

Objective:To explore the effect of high-viscosity bone cement percutaneous kyphoplasty(PKP)on the degree of intraoperative dispersion and postoperative fractures in the treatment of severe osteoporotic vertebral compression fractures of the thoracolumbar spine.Methods:A retrospective analysis of 78 cases of thoracolumbar vertebral compression fractures undergoing PKP in our department from February 2016 to April 2019 was performed.39 cases used High-viscosity bone cement injection(observation group),39 cases were injected with ordinary bone cement(control group),and the postoperative follow-up for 0.5-1 year was performed.The VAS scores,X-rays and CT before and after the operation were recorded;the height of the anterior and posterior edges of the vertebral body,Cobb angle in the two groups were measured;the degree of bone cement diffusion were compared;the bone cement leakage rate and the re-fracture of the adjacent segment vertebral body rate were analyzed between the two groups.Results:There was no significant difference in the amount of bone cement injected between the observation group and the control group(P>0.05);the time from preparation to injection was lower than that in the control group,and the operation time was longer than that in the control group(P<0.05);There was no statistically significant difference in Cobb angle and the height of the anterior and posterior vertebrae in the two groups before treatment(P>0.05).After treatment,the Cobb angle of both groups was lower than that before treatment,and the height of the injured vertebral anterior and posterior edge increased,but Cobb angle in the observation group was lower than that of the control group,the height of the injured vertebral anterior and posterior edge was higher than that in the control group(P<0.05).The percentage of bone cement dispersion I°in the observation group was higher than that in the control group(P<0.05);No adjacent segmental vertebral fractures were observed during the follow-up period in the observation group and there was 5.13%adjacent segmental vertebral fractures in the control group(P<0.05).No bone cement leakage occurred in either group.Postoperative VAS scores of both groups were lower than those before surgery,and the score in the control group was higher than that in the observation group(P<0.05).Conclusion:For patients with osteoporotic thoracolumbar fractures,high-viscosity bone cement during PKP can achieve better dispersibility,effectively restore the height and stability of the vertebral body,improve the mechanical properties,and reduce the re-fracture of adjacent segments.It is worthy of clinical promotion.