可注射硫酸钙与聚甲基丙烯酸甲酯混合的骨水泥在骨质疏松性椎体压缩性骨折经皮椎体成形术中的应用

Application of combined bone cement with injectable calcium sulfate and polymethyl methacrylate in percutaneous vertebroplasty for osteoporotic vertebral compression fractures

目的探索可注射硫酸钙与聚甲基丙烯酸甲酯(polymethyl methacrylate,PMMA)混合的骨水泥结合经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗胸腰椎骨质疏松性压缩骨折的临床疗效。方法选取65例单一的老年骨质疏松性椎体压缩性骨折患者,采用随机数字表法分为两组(对照组31例,观察组34例)。两组均采用PVP术式,对照组用PMMA作为椎体填充物,观察组用可注射硫酸钙与PMMA联合的混合骨水泥作为椎体填充物。记录并对比两组患者的手术时间、骨水泥凝固时间、术前及术后1 d及3、6、12个月的视觉疼痛评分(VAS)及复查X线计算并对比椎体前缘压缩程度、骨水泥渗漏率等指标。结果所有受试患者均顺利完成手术,两组间手术时间、骨水泥注入量组间差异无统计学意义(P>0.05)。观察组骨水泥凝固时间较对照组明显缩短(P<0.05);两组患者术后1 d及3、6、12个月回访测得的VAS评分及复查X线,术后VAS评分较术前均明显降低,组间差异无统计学意义(P>0.05);复查X线发现观察组骨水泥渗漏2例(5.9%)明显低于对照组7例(22.6%)(P<0.05);两组术后椎体高度均较术前有改善(P<0.05),均未发现椎体再塌陷。结论可注射硫酸钙与PMMA联合的混合骨水泥比单纯的PMMA凝固时间短、流动性低,可以有效降低椎体成形术中骨水泥渗漏的发生,临床疗效确切。

Objective To investigate the clinical effect of combined bone cement with injectable calcium sulfate and polymethyl methacrylate in percutaneous vertebroplasty for osteoporotic vertebral compression fractures.Methods Sixty-five patients with single-segment osteoporotic vertebral compression fractures from January 2019 to June 2020 were enrolled,and randomly divided into control group(n=31)and trial group(n=34).Both of them were applied with percutaneous vertebroplasty.The control group received traditional percutaneous vertebroplasty with polymethyl methacrylate,and the trial group received percutaneous vertebroplasty with combined bone cement.The operation time,the amount of injected bone cement,and the solidifying time of bone cement were recorded and compared.The rate of bone cement leakage,the visual analog scale scores and the percentage of anterior height compression of both groups at baseline and 1 day,3 month,6 month and 12 month after operation were recorded.Results The operations in both groups were successfully completed.The operation time,and the amount of injected bone cement between the two groups had no significant difference(P>0.05).The solidifying time of bone cement in the trial group was significantly shorter than that in the control group(P<0.05).The postoperative VAS scores of both groups were significantly lower than those at baseline,while there were no significant differences between the two groups.According to the postoperative X rays,there were 2 patients with bone cement leakage in the trial group(5.9%),while there were 7 patients with bone cement leakage in the control group(22.7%).The rate of bone cement leakage of the trial group was significantly lower than that in the control group(P<0.05).The percentage of anterior height compression of both groups after operation were significantly lower than those of before operation,with no occurring of refracture.Conclusion The application of combined bone cements with injectable calcium sulfate and polymethyl methacrylate in percutaneous vertebroplasty for osteoporotic vertebral compression fractures could achieve good clinical efficacy.This kind of combined bone cement could significantly decrease the rate of bone cement leakage in percutaneous vertebroplasty for its shorten solidifying time and lower flow property compared with those of PMMA alone.