PKP术中不同注入量高粘度骨水泥治疗骨质疏松性腰椎骨折的疗效分析

The efficacy and safety of PKP with different doses of high-viscosity bone cement in the treatment of osteoporotic lumbar vertebral fracture

目的探讨经皮椎体后凸成形术(PKP)术中不同注入量高粘度骨水泥治疗骨质疏松性腰椎骨折(OLVF)的疗效及安全性。方法前瞻性收集2016年9月至2018年9月本院OLVF患者150例,男84例,女66例,年龄(60±8)岁。依据随机数字表分为高量组、中量组、低量组,每组50例,高量组、中量组、低量组PKP术中高粘度骨水泥注入量分别为5.0~7.0 ml、3~4.9 ml、<3.0 ml,比较三组疗效及安全性。结果150例患者获得满意随访,随访时间(19±7)个月。高量组、中量组、低量组手术时间、术中出血量比较,差异无统计学意义(P>0.05);高量组和中量组术后3、6个月椎体前缘高度[(27.3±3.1)mm、(26.0±2.7)mm和(26.9±3.0)mm、(25.7±2.8)mm]明显高于低量组[(23.8±2.8)mm、(21.3±2.5)mm],高量组和中量组术后3、6个月Cobb角及疼痛视觉模拟评分法(VAS)、Oswestry功能障碍指数问卷表(ODI)评分[(40.2±4.7)°、(41.5±4.8)°、(2.6±0.4)分、(1.6±0.3)分、(25.8±3.5)分、(26.9±3.5)分和(40.9±4.8)°、(42.1±4.8)°、(2.6±0.4)分、(1.6±0.3)分、(26.2±3.5)分、(27.2±3.7)分]明显低于低量组[(46.3±5.3)°、(47.8±5.6)°、(3.3±0.4)分、(2.3±0.4)分、(33.3±4.1)分、(34.3±4.2)分],差异有统计学意义(F=25.371、18.914、29.334、22.457、34.276、30.217、29.364、20.071,均P<0.001);高量组骨水泥渗漏率(28.00%)明显高于中量组和低量组(8.00%和4.00%),差异有统计学意义(χ^(2)=10.241,P=0.005)。结论PKP术中不同注入量高粘度骨水泥治疗OLVF的疗效及安全性存在一定的差异,其中注入中量(3~4.9 ml)高粘度骨水泥可获得良好的疗效及安全性,值得临床推广。

Objective To discuss the efficacy and safety of percutaneous kyphoplasty(PKP)with different doses of high-viscosity bone cement in the treatment of osteoporotic lumbar vertebral fracture(OLVF).Methods The 150 patients with OLVF in our hospital from September 2016 to September 2018 were selected,there were 84 males and 66 females,aged(60±8)years.They were divided into high-dose group,medium-dose group and low-dose group according to the random number table,50 cases in each group.The injections of high-viscosity bone cement were 5.0-7.0 ml,3-4.9 ml and<3.0 ml in high-dose group,medium-dose group and low-dose group respectively,and the efficacy and safety of the three groups were compared.Results The 150 patients were followed up satisfactorily for(19±7)months.There was no significant difference in operation time and intraoperative bleeding between high-dose group,medium-dose group and low-dose group(P>0.05).The anterior height of vertebral body in high-dose group and mediumdose group[(27.3±3.1)mm,(26.0±2.9)mm and(26.9±3.0)mm,(25.7±2.8)mm]was significantly higher than that in low-dose group[(23.8±2.8)mm,(21.3±2.5)mm]at 3 and 6 months after operation,the Cobb angle,pain visual analogue score(VAS)and Oswestry dysfunction index(ODI)scores in high-dose group and mediumdose group[(40.2±4.7)°,(41.5±4.8)°,(2.6±0.4)scores,(1.6±0.3)scores,(25.8±3.5)scores,(26.9±3.5)scores and(40.9±4.8)°,(42.1±4.8)°,(2.6±0.4)scores,(1.6±0.3)scores,(26.2±3.5)scores,(27.2±3.7)scores]were significantly lower than those in low-dose group[(46.3±5.3)°,(47.8±5.6)°,(3.3±0.4)scores,(2.3±0.4)scores,(33.3±4.1)scores,(34.3±4.2)scores]at 3 and 6 months after operation,the difference was statistically significant(F=25.371,18.914,29.334,22.457,34.276,30.217,29.364,20.071,all P<0.001).The leakage rate of bone cement in high-dose group(28.00%)was significantly higher than that in medium-dose group and low-dose group(8.00%and 4.00%),the difference was statistically significant(χ^(2)=10.241,P=0.005).Conclusions There are some differences in the efficacy and safety of different doses of high-viscosity bone cement in the treatment of OLVF during PKP,and the middle dosage(3-4.9 ml)of high-viscosity bone cement can achieve good efficacy and safety,it's worth for further clinical promotion.