骨水泥分布形态对经皮椎体成形术疗效的影响

The influence of distribution morphology of bone cement on the effect after percutaneous vertebroplasty

目的 探讨骨水泥分布形态对经皮椎体成形术(PVP)治疗骨质疏松性椎体压缩骨折(OVCF)疗效的影响。方法 将156例采用PVP治疗的OVCF患者依据骨水泥分布形态不同分为A组(骨水泥分布呈H型,91例)、B组(骨水泥分布呈T型,49例)和C组(骨水泥分布呈O型,16例)。比较3组手术时间、术中出血量、骨水泥注入量、骨水泥渗漏率、邻近椎体骨折发生率、疼痛VAS评分、伤椎后凸Cobb角。结果 患者均获得随访,时间17~36(25.1±7.6)个月。手术时间、术中出血量及骨水泥渗漏率3组比较差异均无统计学意义(P>0.05)。骨水泥注入量A组>B组>C组(P<0.01)。邻近椎体骨折发生率A组<B组<C组(P<0.05)。3组疼痛VAS评分术后2 d与术前比较明显降低(P<0.05),组间比较差异均无统计学意义(P>0.05)。3组伤椎后凸Cobb角术后1年、2 d与术前比较均明显减小(P<0.05),术后1年与术后2 d比较差异均无统计学意义(P>0.05),组间比较差异均无统计学意义(P>0.05)。结论 3种骨水泥形态对PVP治疗OVCF的疗效无明显影响,但是当骨水泥在椎体内呈T型或H型分布时,能使伤椎终板获得立体支撑,在稳定骨折、减轻疼痛的基础上,起到平衡载荷的作用,可降低邻近椎体骨折发生率。

Objective To investigate the effect of bone cement distribution morphology on the efficacy of percutaneous vertebroplasty(PVP)for treatment of osteoporotic vertebral compression fracture(OVCF).Methods A total of 156 patients with OVCFs treated with PVP were divided into group A(type-H bone cement distribution,91 cases),group B(type-T bone cement distribution,49 cases)and group C(type-O bone cement distribution,16 cases),according to different distribution morphology of bone cement.The operation time,intraoperative blood loss volume,bone cement injection volume,bone cement leakage rate,incidence ratio of adjacent vertebral fractures,pain VAS,and kyphotic Cobb angle of the injured vertebrae were compared among the three groups.Results All patients were followed up for 17~36(25.1±7.6)months.There were no statistical differences in operation time,intraoperative blood loss and bone cement leakage rate among the three groups(P>0.05).Bone cement injection volume:group A>group B>group C(P<0.01),the incidence rate of adjacent vertebral fracture:group A<group B<group C(P<0.05).The pain VAS of the 3 groups:at 2 d after surgery,which were significantly decreased than before surgery(P<0.05),while there was no statistical significance among three groups(P>0.05).The kyphotic Cobb angles of injured vertebrae:they were significantly decreased at 1 year and 2 d after surgery,compared with those before surgery(P<0.05),and there was no statistical significance between 1 year and 2 d after surgery(P>0.05),while there was no statistical significance among the three groups(P>0.05).Conclusions The three kinds of bone cement morphology have no significant effects on the efficacy of PVP for treatment of OVCFs,but when the bone cement is distributed in type-T or H morphology in the vertebrae,the injured vertebral endplate can obtain independent support,on the basis of stabilizing the fracture and relieving pain,which play a role of balancing load,and can reduce the incidence rate of adjacent vertebral fracture.