单侧椎体成形术治疗骨质疏松骨折时骨水泥不同形态分布的临床疗效

Clinical efficacy of different distribution of bone cement in the treatment of osteoporotic fractures by unilateral vertebroplasty

目的探究单侧椎体成形术(PVP)治疗骨质疏松骨折时骨水泥不同形态分布对临床疗效的影响。方法选取我院收治的PVP患者88例,以术后X线检查时骨水泥情况分为O形组(骨水泥呈聚集团块样分布)和H形组(骨水泥呈弥散蜂窝状分布),每组44例。比较两组各项指标。结果两组骨水泥注射平均注射量、骨水泥渗漏比较,P<0.05。两组术前、术后1 d、术后6个月视觉模拟评分(VAS)比较,P>0.05;而术后1个月VAS评分比较,P<0.05。两组术前、术后3个月及术后1年伤椎Cobb角、矫正度比较,P均>0.05。术前两组椎体前缘高度、椎体中部高度及椎体压缩率比较,P>0.05;同组比较:椎体前缘高度、椎体中部高度均较手术前升高,椎体压缩率较手术前降低(P<0.05);两组术后椎体前缘高度、椎体中部高度、椎体压缩率比较,P>0.05。术前两组Oswestry功能障碍指数问卷(ODI)、腰椎按照日本骨科协会评估治疗(JOA)评分比较,P>0.05;同组比较:术后ODI评分低于术前,JOA评分高于术前(P>0.05);两组术后ODI评分、JOA评分比较,P>0.05。结论单侧穿刺PVP操作中,无需为实现患椎完全弥散故意加大穿刺针穿刺角度,继而减少对重要结构的破坏、降低骨水泥渗漏及其他危险。无论骨水泥是何种形态均可取得较好疗效,但骨水泥的分布形式对渗漏率有显著影响。

Objective To explore the effect of different distribution of bone cement in the treatment of osteoporotic fractures by unilateral puncture percutaneous vertebroplasty(PVP).Methods 88 PVP patients were divided into two groups:44 cases in group O(bone cement distributed as aggregates)and 44 cases in group H(bone cement distributed as diffuse honeycomb).The indexes of the two groups were compared.Results The injection amount and leakage of bone cement were compared between the two group with P>0.05.The comparison of visual analogue score(VAS)between the two groups before operation,1 day after operation and 6 months after operation was with P>0.05,while the comparison 1 month after operation was with P<0.05.There was no significant difference in the Cobb angle and correction degree of injured vertebrae between the two groups before operation,3 months and 1 year after operation.Before operation,the comparison of anterior edge height,middle height and compression ratio of vertebral body between the two groups was with P>0.05;In the same group,the anterior edge height and middle height of vertebral body were higher than those before operation,and the compression ratio of vertebral body was lower than that before operation(P<0.05);after operation,the comparison of anterior edge height,middle height and compression ratio of vertebral body between the two groups was with P>0.05.The comparison of preoperative Oswestry Disability Index questionnaire(ODI)score and Japanese Orthopaedic Association(JOA)score were with P>0.05.Conclusion In the treatment of osteoporotic fractures by PVP,there is no need to deliberately increase the puncture angle of the puncture needle to achieve complete diffusion of the affected vertebra,reduce damage to important structures,bone cement leakage and other risks.No matter what form of bone cement is,better curative effect can be obtained,but the distribution form of bone cement has a significant effect on the leakage rate.