对比不同骨水泥类型椎体后凸成形术治疗多发性骨髓瘤椎体压缩性骨折的效果

Comparison of different cement types for vertebral body kyphoplasty in treatment of vertebral compression fractures in multiple myeloma

目的 对比不同骨水泥类型椎体后凸成形术(percutaneous kyphoplasty, PKP)治疗多发性骨髓瘤(multiple myeloma, MM)椎体压缩性骨折(vertebral compression fracture, VCF)患者的效果。方法 选取郑州大学第一附属医院72例MM VCF患者(2020年7月—2022年7月),按随机数字表法分成2组,均行PKP治疗,其中采用低黏度骨水泥注入的36例MM VCF患者列为B组,采用高黏度骨水泥注入的36例MM VCF患者列为A组。对比两组手术指标、骨水泥渗漏情况、手术前后视觉模拟评分法(VAS)评分、Oswestry功能障碍指数(ODI)、Cobb角、伤椎前缘高度(AVH)、血清碱性磷酸酶(ALP)、Ⅰ型胶原C末端肽(CTX-Ⅰ)、骨钙素(BGP)含量。结果 两组术中失血量、骨水泥注入量相比无明显差异(P>0.05);A组手术耗时较B组长(P<0.05);A组骨水泥总渗漏率8.33%(3/36)较B组33.33%(12/36)低(P<0.05);术后3个月、6个月A组ODI、VAS评分较B组低(P<0.05);术后3个月、6个月A组Cobb角较B组低,AVH较B组高(P<0.05);术后3个月、6个月A组血清ALP、BGP含量较B组高,CTX-Ⅰ含量较B组低(P<0.05)。结论 PKP治疗MM VCF患者术中应用高黏度骨水泥注入虽会延长手术耗时,但可进一步减少骨水泥渗漏,减轻疼痛感,恢复伤椎AVH、Cobb角,提升椎体功能及椎体稳定性,改善机体骨代谢水平。

Objective To compare the efficacy of kyphoplasty(PKP)with different bone cement types in the treatment of multiple myeloma(MM)vertebral compression fracture(VCF).Methods Totally 72 MM VCF patients(from July 2020 to July 2022)in our hospital were selected and divided into two groups according to random number table method.All patients received PKP treatment.36 MM VCF patients receiving low viscosity bone cement injection were classified as group B,and 36 MM VCF patients receiving high viscosity bone cement injection were classified as group A.The surgical indexes,bone cement leakage,visual analogue scale(VAS)scores before and after surgery,Oswestry Disability Index(ODI),Cobb Angle,height of injured vertebral front(AVH),serum alkaline phosphatase(ALP),C-terminal peptide of type I collagen(CTX-I),and osteocalcin(BGP)contents of the two groups were compared.Results There were no significant differences in the amount of blood loss and bone cement injection between the two groups(P>0.05).The operation time of group A was longer than that of group B(P<0.05).The total leakage rate of bone cement in group A was 8.33%(3/36)lower than that in group B(33.33%(12/36)(P<0.05).ODI and VAS scores in group A were lower than those in group B at 3 and 6 months after surgery(P<0.05).Cobb Angle of group A was lower and AVH of group B was higher at 3 and 6 months after operation(P<0.05).Serum ALP and BGP contents in group A were higher than those in group B at 3 and 6 months after operation,while CTX-I content was lower than that in group B(P<0.05).Conclusion Although PKP injection of high viscosity bone cement in the treatment of MM VCF patients can prolong the operation time,it can further reduce bone cement leakage,relieve pain,restore the AVH and Cobb Angle of the injured vertebra,improve the vertebral function and stability,and improve the level of bone metabolism in the body.