体位复位后经皮椎体成形术微量骨水泥注入对脊椎骨质疏松压缩性骨折疼痛评分及凝血功能的影响

Effects of percutaneous vertebroplasty with micro-injection of bone cement after postural reduction on the pain score and coagulation function of osteoporotic vertebral compression fracture

目的 探讨体位复位后经皮椎体成形术(percutaneous vertebroplasty,PVP)微量骨水泥注入对脊椎骨质疏松压缩性骨折(osteoporotic vertebral compression fracture,OVCF)患者疼痛评分及凝血功能的影响。方法 纳入2019年1月至2021年6月空军军医大学唐都医院收治的OVCF患者400例,均行体位复位后PVP治疗,根据PVP术中骨水泥注入量分为常量组(207例)和微量组(193例)。比较两组的手术疗效,治疗前后Oswestry功能障碍指数(Oswestry disability index,ODI)、疼痛视觉模拟量表(visual analogue scale,VAS)评分和凝血功能指标的变化,以及术后并发症发生情况。结果 常量组的手术成功率(97.10%)及手术时间[(30.58±4.97)min]与微量组[分别为97.93%、(31.06±5.19)min]比较差异无显著性(P>0.05)。常量组的骨水泥注入量[(5.19±0.41)ml]多于微量组[(3.24±0.27)ml],差异有显著性(P<0.05);两组术后的椎体前缘高度均高于术前,Cobb角均小于术前(P<0.05),但组间比较差异无显著性(P>0.05);两组术后ODI均明显低于术前(P<0.05),但组间比较差异无显著性(P>0.05);两组术后VAS评分均明显低于术前,且微量组明显低于常量组(P<0.05)。术后1h两组凝血酶原时间均明显低于术前,且常量组明显低于微量组,而纤维蛋白原、D-二聚体水平明显高于术前,且常量组明显高于微量组,差异均有显著性(P<0.05)。微量组术后并发症发生率明显低于常量组(P<0.05)。结论 体位复位后PVP微量骨水泥注入治疗OVCF可有效缓解术后疼痛,减轻对患者凝血功能的影响。

Objective To investigate the effects of percutaneous vertebroplasty(PVP) with bone cement micro-injection on pain score and coagulation function in patients with osteoporotic vertebral compression fracture(OVCF) after postural reduction. Method 400 patients with OVCF were enrolled between January 2019 and June 2021, and underwent PVP after postural reduction. According to the bone cement injection volume during PVP, the patients were divided into constant group(207 cases) and micro group(193 cases). The surgical efficacy, Oswestry Disability Index(ODI) and coagulation function indicators before and after treatment were compared between the two groups. Visual Analogue Scale was used to evaluate the pain degree of patients before and after treatment, and the incidence rates of postoperative complications were statistically analyzed. Result There were no significant differences in the success rate of surgery and surgical time between the two groups(P>0.05). The injection volume of bone cement in constant group was more than that in micro group [(5.19±0.41) ml vs(3.24±0.27) ml, P<0.05]. The anterior height of vertebral body after surgery in the two groups was higher than that before surgery, and the Cobb angle was smaller than that before surgery(P<0.05), but the differences were not significant between the two groups(P>0.05). There was no significant difference in comparison of ODI index at each time point between the two groups(P>0.05).The VAS scores at 24 hours and 1 week after surgery were(3.95±0.36) points and(2.90±0.29) points in micro group, which were lower than(4.21±0.31) points and(3.04±0.32) points in constant group(P<0.05). The prothrombin time(PT) in micro group at 1 hour after surgery was longer than that in constant group [(10.35±2.19) s vs(9.51±2.03) s], and the levels of fibrinogen(FBG) and D-dimer(DD)were lower than those in constant group [(3.96±0.43) g/L vs(4.08±0.61) g/L,(93.15±11.78) μg/L vs(116.18±10.63) μg/L, P<0.05].There were no significant differences in incidence rates of bone cement extravasation and adjacent vertebral fracture and re-fracture rate of injured vertebra between the two groups(P>0.05). Conclusion PVP with bone cement micro-injection after postural reduction in the treatment of patients with OVCF can relieve postoperative pain and reduce the impact of surgery on coagulation function.