经皮椎体后凸成形术中骨水泥注入量对老年骨质疏松椎体压缩性骨折患者近远期的影响

Effect of Cement Injection Volume during Percutaneous Vertebral Kyphoplasty on the Near-and Long-term Effects in Elderly Patients with Osteoporotic Vertebral Compression Fractures

目的:探讨经皮椎体后凸成形术(PKP)中骨水泥注入量对老年骨质疏松椎体压缩性骨折(OVCF)患者近远期的影响。方法:选取2019年10月—2021年10月泉州市正骨医院脊柱科收治的190例老年OVCF患者作为研究对象,依据PKP中骨水泥注入量分为低剂量组(2~<4 mL,n=95)和高剂量组(≥4~6 mL,n=95),比较两组患者腰椎稳定性(椎体前缘高度、Cobb角)、Oswestry功能障碍指数(ODI)、疼痛视觉模拟评分法(VAS)评分、骨水泥渗漏及再骨折情况。结果:术后72 h椎体前缘高度,高剂量组患者高于低剂量组,差异有统计学意义(t=3.775,P<0.05);术后72 h Cobb角,高剂量组患者低于低剂量组,差异有统计学意义(t=4.237,P<0.05);两组患者术前、术后72 h、术后6个月ODI和VAS评分比较,差异无统计学意义(t=0.848、1.043、1.115、0.871、1.378、0.745,P>0.05);术后骨水泥渗漏和再骨折情况比较,高剂量组患者高于低剂量组,差异有统计学意义(χ^(2)=9.828、7.816,P<0.05);术后6个月生活质量评分比较,低剂量组患者显著高于高剂量组,差异有统计学意义(t=6.482、7.158、5.282、5.880,P<0.05)。结论:PKP中高剂量骨水泥注入可改善老年OVCF患者近期腰椎稳定性,但不可改善腰椎功能及疼痛,且会增加骨水泥渗漏及再骨折风险,应选择2~<4 mL骨水泥注入。

Objective:To investigate the effect of cement injection volume in percutaneous kyphoplasty(PKP)on the near-and long-term effects of osteoporotic vertebral compression fractures(OVCF)in elderly patients.Methods:A total of 190 elderly OVCF patients admitted to the hospital from October 2019 to October 2021 were selected for the study,and were divided into a low-dose group(2 to<4 mL,n=95)and a high-dose group(≥4 to 6 mL,n=95)on the basis of the amount of bone cement injected in PKP.Lumbar spine stability(anterior vertebral margin height,Cobb angle),Oswestry dysfunction index(ODI),visual analog scale(VAS)for pain,cement leakage and re-fracture were compared between the two groups.Results:The height of the anterior edge of the vertebral body at 72 h postoperatively was higher in patients in the high-dose group than in the low-dose group,and the difference was statistically significant(t=3.775,P<0.05).At 72 h postoperatively,the Cobb angle was lower in the high-dose group than in the low-dose group,and the difference was statistically significant(t=4.237,P<0.05).There was no statistically significant difference in ODI and VAS scores when comparing preoperative,72 h postoperative,and 6 months postoperative(t=0.848,1.043,1.115,0.871,1.378,0.745,P>0.05).Postoperative cement leakage and refracture were higher in the high-dose group than in the low-dose group,and the difference was statistically significant(χ^(2)=9.828,7.816,P<0.05).At 6 months post⁃operatively,the quality of life in the low-dose group was significantly higher than that in the high-dose group,and the difference was statistically significant(t=6.482,7.158,5.282,5.880,P<0.05).Conclusion:High-dose cement injection in PKP improves re⁃cent lumbar stability in elderly patients with OVCF,but does not improve lumbar function and pain,and increases the risk of ce⁃ment leakage and re-fracture.Bone cement injections of 2 to<4 mL should be chosen.