椎体后凸成形术骨水泥弥散分布对治疗骨质疏松性椎体压缩骨折的疗效分析

The Analysis of the Efficacy of Bone Cement Distribution on Clinical after Percutaneous Kyphoplasty of Unilateral Approach for Osteoporotic Vertebral Compression Fractures

目的:探究经单侧入路椎体后凸成形术(PKP)治疗老年骨质疏松性椎体压缩骨折(OVCF),骨水泥在伤椎内分布情况对临床疗效及预后的影响。方法:本研究选取我院2015年3月-2021年7月收治的280例单节段0VCF的老年患者,这些患者均接受PKP治疗。其中男76例,女204例,年龄为60-90岁,平均年龄为(73.89±7.34)岁,伤后平均等待手术时间为(3.09±1.33)天,平均推注骨水泥为(4.73±0.79)mL。根据骨水泥分布的不同分为弥散组(131例)和团块组(149例)。比较2组患者的一般特征(性别、年龄、体质量指数、手术等待时间)、手术特征(手术时间、骨水泥量)和影像学特征(手术前后伤椎Cobb角,手术前后椎体前缘高度、骨水泥的渗漏、术后邻近椎体再骨折)的情况。分别在术前、术后1天、术后1个月和术后1年使用视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)比较2组患者的疗效。结果:2组患者均获得完整的随访,通过分析2组患者在年龄、性别、体质量指数、手术等待时间、手术时间、注入骨水泥量、手术前后Cobb角和椎体前缘高度和骨水泥的渗漏率没有统计学差异(P>0.05)。弥散组患者发生椎体再骨折情况少于团块组,2组比较具有统计学差异(P<0.05)。2组患者术前与术后的VAS和ODI比较无统计学差异,但术后1年的VSA评分弥散组明显低于团块组。结论:经单侧入路行PKP手术,无论是骨水泥弥散分布还是团块分布,患者均能获得满意的疗效,而骨水泥呈弥散分布,具有椎体再骨折发生率低等优势。

Objective:To investigate the effect of cement distribution within the injured vertebrae on clinical outcomes and prognosis in the treatment of osteoporotic vertebral compression fractures(OVCF)in the elderly by unilateral approach to the percutaneous ky-phoplasty(PKP).Methods:In this study,280 elderly patients with single-segment OVCF admited to our hospital from March 2015 to July 2021 were selected to receive PKP treatment.There were 76 males and 204 females,the age ranged from 60 to 90,with a mean age of 73.89±7.34 years,a mean waiting time for surgery after injury of 3.09±1.33 days,and a mean push of 4.73±0.79 ml of bone ce-ment.They were divided into diffusion group(131 patients)and mass group(149 patients)according to the distribution of bone cement.The general characteristics(gender,age,body mass index,waiting time for surgery),surgical characteristics(operation time,bone ce-ment volume)and radiological characteristics(Cobb angle,height of the anterior margin of the vertebral body before and after surgery,leakage of bone cement,and postoperative re-fracture of the adjacent vertebral body)were compared between the two groups.The effi-cacy of the two groups was compared using the visual analogue scale(VAS)and Oswestry Disability Index(ODI)preoperatively,1 day postoperatively,1 month postoperatively,and 1 year postoperatively,respectively.Results:Complete follow-up was obtained in both groups,and there was no statistical diference in age,gender,body mass index,surgical waiting time,operative time,injected cement volume,Cobb angle and anterior vertebral body margin height before and after surgery,and cement leakage rate between the two groups by analysis(P>0.05).There was no statistical difference between the preoperative and postoperative VAS and ODI of the two groups,but the VSA score at 1 year after surgery was significantly lower in the diffuse group than in the mass group.Conclusions:Patients who undergo PKP with a unilateral approach achieve satisfactory outcomes with either diffuse or mass distribution of the cement,which is dif-fusely distributed and has the advantage of a low incidence of vertebral re-fracture.