椎体骨质疏松性骨折椎体成形术后骨水泥弥散分布与疗效的关系

Relationship between the bone cement dispersion and the outcomes of vertebroplasty for vertebral osteoporotic fractures

目的探讨椎体骨质疏松性骨折椎体成形术后骨水泥弥散分布与疗效的关系。方法选择2020年1月至2022年4月在本院行椎体成形术的80例椎体骨质疏松性骨折患者作为研究对象。根据术后骨水泥在伤椎椎体中的弥散体积比,结合骨水泥在正侧位片上的弥散状态,分为1级组(<25%,n=36),2级组(25%~50%,n=24)和3级组(50%~75%,n=20)。比较三组患者术前、术后的Oswestry功能障碍指数(Oswestry disability index,ODI)、伤椎后凸角、伤椎前柱高度变化、术前、术后疼痛视觉模拟评分(visual analog scale,VAS)和并发症发生率。结果三组术后、术后1个月、术后3个月、术后6个月的VAS、ODI均有所改善(P<0.05);三组术后、术后6个月伤椎椎体后凸角均比术前减小(P<0.05),且2级组和3级组术后、术后6个月小于同期1级组(P<0.05),但2级组和3级组比较无统计学差异(P>0.05);三组术后、术后6个月椎体前柱均比术前增高(P<0.05),且2级组和3级组术后、术后6个月椎体前柱均高于1级组(P<0.05),但2级组和3级组比较无统计学差异(P>0.05)。结论椎体成形术后骨水泥的弥散分布会影响术后影像学指标,但弥散体积比达到50%即可获得较为理想的疗效。

Objective To explore the relationship between the dispersion distribution of bone cement and the therapeutic effect after vertebroplasty for vertebral osteoporotic fractures.Methods 80 patients with vertebral osteoporotic fractures who underwent vertebroplasty in our hospital from January 2020 to April 2022 were selected as the study subjects.According to the diffusion volume ratio of bone cement in the injured vertebral body and the dispersion manifestation on the x-ray imaging,they was divided into Grade Group 1(<25%,n=36),Grade Group 2(25%~50%,n=24),and Grade Group 3(50%~75%,n=20).It was compared of the Oswestry disability index(ODI),kyphosis Cobb angle,anterior column height,visual analog scale(VAS),and the complication rates among three groups of patients before and after surgery.Results The postoperative,1-month,3-month and 6-month postoperative VAS and ODI of the three groups improved after surgery(P<0.05).The postoperative and 6-month postoperative kyphosis Cobb angle of the injured vertebral body in the three groups decreased(P<0.05),while Grade Group 2 and 3 were smaller than Grade Group 1(P<0.05).However,there was no statistical difference between Grade Group 2 and 3(P>0.05).The postoperative and 6-month postoperative anterior column of the vertebral body in the three groups increased after surgery(P<0.05),and Grade Group 2 and 3 was higher than that in Grade Group 1(P<0.05).However,there was no statistical difference between Grade Group 2 and 3(P>0.05).Conclusion The diffusion distribution of bone cement after vertebroplasty can affect the postoperative imaging indicators for vertebral osteoporotic fracture patients,and a diffusion volume ratio of 50% can achieve ideal therapeutic effects.