新型骨水泥桥接螺钉系统联合经皮椎体成形术治疗伴椎体内真空裂隙的症状性陈旧性胸腰椎骨质疏松性骨折的疗效

Curative effect of novel bone cement bridging screw system combined with percutaneous vertebroplasty in the treatment of symptomatic chronic thoracic and lumbar osteoporotic vertebral fracture with intravertebral vacuum cleft

目的探讨新型骨水泥桥接螺钉系统联合经皮椎体成形术(PVP)治疗伴椎体内真空裂隙(IVC)的症状性陈旧性胸腰椎骨质疏松性骨折(SCOVF)的疗效。方法采用回顾性病例系列研究分析2016年8月至2018年8月西安交通大学附属红会医院收治的27例伴IVC的SCOVF患者临床资料, 其中男6例, 女21例;年龄69~88岁[(75.2±4.9)岁]。均采用新型骨水泥桥接螺钉系统联合PVP治疗。记录手术时间、骨水泥注入量、有无骨水泥渗漏或移位等并发症。比较术前、术后1 d及末次随访时椎体指数(VBI)、椎体角(VBA)、双节段Cobb角(BCA)、视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)。比较术前及末次随访时健康调查简表(SF-36)评分及Odom标准评估疼痛缓解和神经功能恢复情况。结果患者均获随访36~48个月[(40.2±3.7)个月]。手术时间为30~70 min[(49.6±10.8)min], 骨水泥注入量为3~6 ml[(34.7±0.9)ml]。术中发生骨水泥渗漏4例(15 %), 其中3例为椎体侧方渗漏, 1例为病椎上位椎间盘渗漏。术后至末次随访期间均未出现骨水泥移位。患者术前VBI、VBA、BCA、VAS和ODI分别为(43.1±5.9)%、(21.0±2.6)°、(45.0±6.3)°、7.6(7.0, 8.0)分和(79.9±7.6)%;术后1 d分别为(78.7±2.6)%、(12.7±2.1)°、(26.1±4.7)°、3.2(3.0, 4.0)分和(50.0±9.3)%;末次随访时分别为(78.0±2.3)%、(13.2±2.4)°、(27.1±4.9)°、2.0(2.0, 2.0)分和(22.9±5.1)%。与术前比较, 术后1 d及末次随访时VBI、VBA、BCA、VAS和ODI差异有统计学意义(P均<0.05)。与术后1 d比较, 末次随访时VAS、ODI差异有统计学意义(P均<0.05)。术前SF-36评分在躯体功能、躯体角色、肌体疼痛、活力和社会功能方面分别为45.2(40.0, 50.0)分、28.7(25.0, 50.0)分、15.9(10.0, 22.0)分、48.3(40.0, 60.0)分和29.2(25.0, 37.5)分, 与末次随访时的78.0(75.0, 85.0)分、75.0(75.0, 75.0)分、68.1(64.0, 74.0)分、62.0(55.0, 70.0)分和34.7(25.0, 37.5)分比较, 差异有统计学意义(P均<0.05)。在总体健康状况、情绪功能和心理健康方面差异无统计学意义(P均>0.05)。根据Odom标准, 优异19例, 良好7例, 满意1例, 差0例, 优良率为96%。结论新型骨水泥桥接螺钉系统联合PVP治疗伴IVC的SCOVF患者术后无骨水泥移位发生, 固定复位效果满意, 疼痛缓解明显, 功能恢复良好。

Objective To investigate the efficacy of the novel bone cement bridging screw system combined with percutaneous vertebroplasty(PVP)in the treatment of symptomatic chronic osteoporotic vertebral fractures(SCOVF)with intravertebral vacuum cleft(IVC).Methods A retrospective case series study was used to analyze the clinical data of 27 patients with SCOVF admitted to Honghui Hospital affiliated to Xi′an Jiaotong University from August 2016 to August 2018,including 6 males and 21 females;age 69-88 years[(75.2±4.9)years].All patients were treated by the novel bone cement bridging screw combined with PVP.The operation time,amount of bone cement injected and occurrence of bone cement leakage or displacement were recorded.The vertebral body index(VBI),vertebral body angle(VBA),two-segment Cobb angle(BCA),visual analogue score(VAS)and Oswestry disability index(ODI)were compared preoperatively,at day 1 after operation and at the last follow-up.The results of the MOS 36-item short form health survey(SF-36)and Odom′s criteria were compared preoperatively and at the last follow-up to evaluate pain relief and neurological recovery.Results All patients were followed up for 36-48 months[(40.2±3.7)months].The operation time was 37-70 minutes[(49.6±10.8)minutes],with the amount of bone cement injected for 3-6 ml[(34.7±0.9)ml].Intraoperative bone cement leakage occurred in 4 patients(15%),among which 3 had lateral vertebral leakage and 1 superior intervertebral disc leakage.There was no bone cement displacement during the postoperative period to the last follow-up.The VBI,VBA,BCA,VAS and ODI were(43.1±5.9)%,(21.0±2.6)°,(45.0±6.3)°,7.6(7.0,8.0)points,(79.9±7.6)%preoperatively,were(78.7±2.6)%,(12.7±2.1)°,(26.1±4.7)°,3.2(3.0,4.0)points,(50.0±9.3)%at day 1 after operation,and were(78.0±2.3)%,(13.2±2.4)°,(27.1±4.9)°,2.0(2.0,2.0)points,(22.9±5.1)%at the last follow-up.There were significant differences in above five measures at day 1 after operation and at the final follow-up in comparison with the preoperative values(all P<0.05),and their values measured at day 1 after operation and at the final follow-up were also significantly different(all P<0.05).The SF-36 score in physical function,role physical,body pain,vitality and social function was 45.2(40.0,50.0)points,28.7(25.0,50.0)points,15.9(10.0,22.0)points,48.3(40.0,60.0)points,29.2(25.0,37.5)points preoperatively,significantly different from 78.0(75.0,85.0)points,75.0(75.0,75.0)points,68.1(64.0,74.0)points,62.0(55.0,70.0)points,34.7(25.0,37.5)points at the last follow-up(all P<0.05).However,there were no significant differences in SF-36 before operation and at the last follow-up in dimensions of general health,emotional function and mental health(all P>0.05).According to Odom′s criteria,19 patients were graded as excellent,7 good,1 fair and 0 poor,with an excellent and good rate of 96%.Conclusion For SCOVF patients with IVC,the novel bone cement bridging screw system combined with PVP has advantages of no displacement of bone cement,satisfactory fixation,significant pain relief and satisfactory functional recovery.