骨水泥不同分布形态对脊柱骨质疏松骨折单侧PVP手术效果及预后的影响

Effects of different distribution patterns of bone cement on the outcome and prognosis of unilateral PVP surgery for spinal osteoporotic fractures

目的探讨骨水泥不同分布形态对脊柱骨质疏松骨折单侧PVP手术效果及预后的影响。方法回顾性分析2019年3月至2022年3月西安国际医学中心医院收治的80例脊柱骨质疏松骨折行单侧PVP手术患者的临床资料,根据X线检查骨水泥分布情况进行分组,其中42例骨水泥分布互相连通的致密型患者纳入观察组,38例骨水泥分布互相分离的弥散型患者纳入对照组。比较两组患者的手术时间、术中骨水泥注入量、骨水泥渗漏率、术后再发骨折发生情况;测量患者手术前后的前缘、后缘椎体高度,计算前、后缘高度比,测量术前、术后3 d局部后凸角(Cobb角)情况;于术前、术后1 d、3个月、12个月采用视觉疼痛评分(VAS)、Oswestry功能障碍量表(ODI)评估两组患者的疼痛及生活质量。结果观察组患者的手术时间为(36.65±8.05)min,明显短于对照组的(40.76±9.16)min,差异有统计学意义(P<0.05);两组患者的透视次数、住院时间、前后缘高度比、术前及术后3 d的Cobb角比较差异均无统计学意义(P>0.05);观察组患者的骨水泥灌注量为(3.34±1.09)mL,骨水泥渗漏6例(14.29%),明显少于对照组的(4.88±1.15)mL和15例(29.47%),差异均有统计学意义(P<0.05);观察组和对照组患者术后再发骨折发生率分别为11.90%、13.16%,差异无统计学意义(P>0.05);两组患者术后VAS评分及ODI评分较术前均降低,且观察组患者术后1 d、3个月的VAS评分明显低于对照组,术后3个月、12个月的ODI评分也明显低于对照组,差异均有统计学意义(P<0.05)。结论骨水泥分布形态是影响PVP手术疗效及预后的重要因素,骨水泥分布互相连通的致密型相较于弥散型效果更优,有助于缩短手术时间,骨水泥渗漏率少,且能缓解术后疼痛,提高生活质量。

Objective To investigate the effect of different distribution patterns of bone cement on the outcome and prognosis of unilateral PVP surgery for osteoporotic fractures of spine.Methods The clinical data of 80 patients with spinal osteoporosis fractures undergoing unilateral PVP surgery who admitted to Xi'an International Medical Center Hospital from March 2019 to March 2022 were retrospectively analyzed.According to the distribution of bone cement by X-ray examination,the patients were divided into two groups:the observation group(42 dense patients with interconnected bone cement distribution)and the control group(38 dispersive patients with separated bone cement distribution).The operation time,intraoperative bone cement injection amount,bone cement leakage rate,and postoperative recurrence fractures were compared between the two groups.The anterior and posterior vertebral body height of patients were measured before and after surgery,the ratio of the anterior and posterior vertebral body heights was calculated,and the local posterior convex angle(Cobb angle)was measured before and 3 days after surgery.Visual Analogue Scale(VAS)and Oswestry Disability Index(ODI)were used to assess pain and quality of life in the two groups before surgery,at 1 day,3 months,and 12 months after surgery.Results The operation time of the observation group was(36.65±8.05)min,which was significantly shorter than(40.76±9.16)min in the control group(P<0.05).There were no significant differences in the number of fluoroscopy,length of hospital stay,the ratio of the anterior and posterior vertebral body heights,and Cobb angle before and 3 days after surgery(P>0.05).The bone cement perfusion volume in the observation group was(3.34±1.09)mL,and bone cement leakage was found in 6 cases(14.29%),significantly lower than(4.88±1.15)mL and 15 cases(29.47%)in the control group(P<0.05).The incidence of postoperative recurrence of adjacent fractures in the two groups was 11.90%and 13.16%,respectively,with no statistically significant difference(P>0.05).Postoperative VAS scores and ODI scores of the two groups were lower than those before surgery;VAS score of the observation group was significantly lower than that of the control group at 1 d and 3 months after surgery;ODI score of the observation group was also significantly lower than that of the control group at 3 and 12 months after surgery;the differences were statistically significant(P<0.05).Conclusion The distribution pattern of bone cement is an important factor affecting the outcome and prognosis of PVP surgery.Compared with diffuse type,dense type with interconnected bone cement distribution has better effect,which can help shorten the operation time,reduce the leakage rate of postoperative cement,relieve postoperative pain,and improve the quality of life.