不同骨水泥分布形态对PKP治疗OVCF中远期疗效的影响及伤椎再骨折的相关性

The effect of different bone cement distribution on the medium and long term efficacy of PKP in the treatment of OVCF and the correlation study of vertebral fracture

目的:研究不同骨水泥分布形态对经皮椎体后凸成形术(PKP)在骨质疏松性椎体压缩性骨折(OVCF)的中远期临床疗效影响及与伤椎再骨折相关性研究。方法:收集2015年4月~2020年4月在昆明市中医医院骨伤科行PKP术的OVCF患者共437例。根据骨水泥分布形态进行分组,经两位观察员独立评估分为O型组和H型组,如有争议时,则交由第三观察员进行评估,最终分为O型组(n=248例)和H型组(n=189例)。统计并分析两组患者术前、术后的疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、后凸Cobb角以及伤椎再骨折发生率。结果:O型组和H型组在术前、术后3个月的ODI评分、VAS评分组间比较,差异均无统计学意义(P>0.05);H型组在术后第2天ODI评分、VAS评分均显著低于O型组,差异有统计学意义(P<0.05),两组Cobb角在术前、术后2 d、术后3个月组间比较,差异无统计学意义(P>0.05),H组术后2年伤椎骨折再发生率明显低于O组,组间比较差异具有统计学意义(P<0.05)。结论:在早期临床症状改善、伤椎骨折再发生率H型骨水泥分布形态明显优于O型,临床工作值得优先推荐。

Objective To study the effect of different bone cement distribution on the medium and long term clinical effect of percutaneous kyphoplasty(PKP) on osteoporotic vertebral compression fracture(OVCF) and its correlation with vertebral fracture.Method A total of 437 OVCF patients who underwent PKP in the Department of Orthopedics, Kunming Hospital of Traditional Chinese Medicine from April 2015 to April 2020 were collected and divided into type O type group and H type group after independent evaluation by two observers, according to the distribution and shape of bone cement.If there was any dispute, the patients were evaluated by the third observer, and finally divided into O type group(n=248) and H type group(n=189).The visual analogue scale(VAS), Oswestry Disability index(ODI),Cobb’s Angle of kyphosis and incidence of refracture of injured vertebrae before and after surgery were analyzed and compared between the two groups.Results There was no difference in ODI score and VAS score between O type group and H type group before operation and 3 months after operation(P>0.05).The ODI score and VAS score of H type group were significantly lower than those of O type group on the second day after operation(P<0.05), and there was no difference in Cobb’s Angle between the two groups before operation, 2 days after operation, and 3 months after operation(P>0.05).The recurrence rate of injured vertebral fracture in H type group was significantly lower than that in O type group at 2 years after operation, the difference between the two groups was statistically significant(P<0.05).Conclusion The distribution pattern of H-type bone cement is significantly better than that of O-type bone cement in the early improvement of clinical symptoms and re-incidence of injured vertebral fracture, clinical work should be recommended first.